内镜超声检查对溃疡性结肠炎的诊断价值探讨

Endoscopic ultrasonography in diagnosis of ulcerative colitis

目的 探讨内镜超声检查对溃疡性结肠炎的诊断价值。方法 对 3 1例活动期溃疡性结肠炎行超声内镜检查 ,分析肠壁、肠旁淋巴结等影像学特征及与病变活动程度的关系。结果 ①病变区域管壁增厚 ,平均管壁总厚度为 ( 6.62±0 .5 8)mm。管壁各层次增厚率分别为 :M 77.4% ( 2 4/ 3 1)、SM 93 .5 % ( 2 9/ 3 1)、MP 64 .5 % ( 2 0 / 3 1)、S 71.0 % ( 2 2 / 3 1) ,其中81.8%MP层增厚见于Baron’Ⅳ级 ,明显高于Ⅱ级 ( 0 % )及Ⅲ级 ( 3 3 .3 % )组 (P <0 .0 5 )。②管壁层次结构大多清晰可辨。77.4%出现M层异常变化 ,其中 2 2 .6%显示 3层、5 4.8%为 4层管壁声像图 ,前者均见于Baron’Ⅳ级 ,后者 72 .7%分布于Ⅳ级组 ,明显高于Ⅱ、Ⅲ级组 (P <0 .0 5 )。③ 6.5 %黏膜下层内可见直径大于 2mm的脉管样低回声结构 ,5 4.8%发现息肉。④于 5 8.1%肠壁旁发现炎性肿大的淋巴结 ,其分布与Baron’分级无关 ;未见脓肿或窦道等病灶。结论 EUS能够显示炎症侵袭肠壁的深度 ,与病变的严重程度相一致 ,有助于临床对病情及预后的判断和治疗方案的选择。

Objective To evaluate the value of endoscopic ultrasonography (EUS) in the diagnosis of ulcerative colitis(UC). Methods EUS was carried out in 31 patients with active ulcerative colitis. Wall features and pericolorectal lymph nodes were documented systematically. The correlation between Baron' endoscopic grades in ulcerative colitis and colorectal wall structure were evaluated ulteriorly. Results The total wall thickness was increased, with (6.62±0.58) mm on average. The thickening of the mucosal (M), submucosal (SM), muscularis propria (MP) and serosa (S) or adventitia (A) layers of the colonic wall were observed in patients with ulcerative colitis for: M 77.4%(24/31), SM 93.5%(29/31), MP 64.5% (20/31), S 71.0%(22/31), respectively. Among them, 81.8% MP layer was thickening in Baron' grades 4, significantly higher than that of Baron' grades 2 (0%) and 3 (33.3%) cases ( P <0.05). The layers of the colorectal wall were clearly seen in most of these patients. In patients with acute UC the mucosa appeared abnormal in 77.4% (24/31) of cases, 7 cases (31.4%) of a three layer structure and 17 cases (54.8%) of a four layer structure. The former was seen all in the Baron' grades 4 cases, the latter was observed in 16 patients (72.7%) of Baron' grades 4, significantly higher than that of Baron' grades 2 (0%) and 3 (16.7%) cases ( P <0.05). Submucosa and muscularis propria layer were also always preserved. Thickening and increased echogenicity of the fifth layer was seen in 22 (71.0%) patients. Two cases (6.5%) of enlarged vessels and 17 cases (54.8%) of poly were observed. The existence of pericolorectal pathological lymph nodes was found in 18 patients (58.1%), no significant difference between the subgroups of Baron' grades. Conclusion EUS can show the depth of inflammation in UC, and the EUS images was correlated with the severity of colonoscopic changes. EUS is a reliable and useful diagnostic tool to assess the severity and anticipate the prognosis of active ulcerative colitis, and beneficial to choose the therapeutic project.