Utility of endoscopic ultrasound and endoscopy in diagnosis and management of hepatocellular carcinoma and its complications: What does endoscopic ultrasonography offer above and beyond conventional cross-sectional imaging?

Hepatocellular carcinoma constitutes over 90% of the primary liver tumors, the rest being cholangiocarcinoma. It has an insidious presentation, which is responsible for the delayed presentation. Hence, the management strategy relies on screening to diagnose it an early stage for curative resection and/or treatment with local ablative techniques or chemotherapy. However, even with different screening programs, more than 60% of tumors are still detected at an advanced stage, leading to an unchanged mortality rate, thereby implying a room for improvement in the screening and diagnostic process. In the last few years, there has been evolution of utility of endoscopy, specifically endoscopic ultrasonography along with Fine needle aspiration, for this purpose, which we comprehensively review in this article.

EUS联合ERCP诊治不明原因肝外胆管阻塞性黄疸分析

目的分析内镜超声（EUS）联合内镜逆行胰胆管造影（ERCP）诊治不明原因肝外胆管阻塞性黄疸的效果。方法选择2012年5月～2013年11月本院经B超、CT和MRCP检查诊断为不明原因肝外胆管阻塞性黄疸患者60例，对其采用EUS、ERCP检查，观察检查结果。结果60例患者中采用内镜超声（EUS）检查诊断胆道微结石患者54例，采用ERCP结合乳头扩张术或EST结合胆道取石术证实胆道微结石55例；5例为胆总管下端炎性狭窄并行胆道内支架植入术。内镜超声（EUS）与内镜逆行胰胆管造影（ERCP）及EUS联合ERCP检查结果准确性有差异，但不明显，差异不具有统计学意义（P〉0．05）。结论肝外胆管阻塞的主要原因是胆道微结石，采用EUS、ERCP检查不明原因肝外胆管阻塞性黄疸准确性高、安全，如果两者联合准确性更高，具有较高的临床应用价值。

Is endoscopic ultrasonography essential for endoscopic resection of small rectal neuroendocrine tumors?

AIM To evaluate the importance of endoscopic ultrasonography(EUS) for small(≤ 10 mm) rectal neuroendocrine tumor(NET) treatment.METHODS Patients in whom rectal NETs were diagnosed by endoscopic resection(ER) at the Pusan National University Yangsan Hospital between 2008 and 2014 were included in this study. A total of 120 small rectal NETs in 118 patients were included in this study. Histologic features and clinical outcomes were analyzed, and the findings of endoscopy, EUS and histology were compared. RESULTS The size measured by endoscopy was not significantly different from that measured by EUS and histology(r = 0.914 and r = 0.727 respectively). Accuracy for the depth of invasion was 92.5% with EUS. No patients showed invasion of the muscularis propria or metastasis to the regional lymph nodes. All rectal NETswere classified as grade 1 and demonstrated an L-cell phenotype. Mean follow-up duration was 407.54 ± 374.16 d. No patients had local or distant metastasis during the follow-up periods. CONCLUSION EUS is not essential for ER in the patient with small rectal NETs because of the prominent morphology and benign behavior.

Clinical course of subepithelial lesions detected on upper gastrointestinal endoscopy

AIM:To evaluate the natural history of subepithelial lesions.METHODS:We reviewed the medical records of 104 159 patients who underwent upper gastrointestinal endoscopy at the Center for Health Promotion of Samsung Medical Center between 1996 and 2003.Subepithelial lesions were detected in 795 patients(0.76%);252 patients were followed using upper gastrointestinal endoscopy for 82.5 ± 29.2 mo(range,12-160 mo;median,84 mo;1st quartile,60 mo;3rd quartile,105 mo).The median interval of follow-up endoscopy was 12 mo(range,6-105 mo;1st quartile,12 mo;3rd quartile,24 mo).RESULTS:The mean patient age was 53 years(range,22-80 years),and the male-to-female ratio was 2.36:1(177/75).The lesion size at initial measurement averaged 8.9 mm(range,2-25 mm;median,8 mm;1st quartile,5 mm;3rd quartile,10 mm).Of the 252 lesions,244(96.8%) were unchanged and 8(3.2%) were significantly increased in size(from 12.9 ± 6.0 to 21.2 ± 12.2 mm) after a mean interval of 59.1 ± 27.5 mo(range,12-86 mo).Surgical resection of lesions was performed when the lesions were ≥ 3 cm in diameter.Two lesions were diagnosed as gastrointestinal stromal tumors with an intermediate or high risk of malignancy and one lesion was classified as a schwannoma.CONCLUSION:Most small subepithelial lesions do not change as shown by endoscopic examination,and regular follow-up with endoscopy may be considered in small,subepithelial lesions,especially lesions < 1 cm in size.

What types of early gastric cancer are indicated for endoscopic ultrasonography staging of invasion depth?

AIM To clarify the diagnostic efficacy and limitations of endoscopic ultrasonography(EUS) and the characteristics of early gastric cancers(EGCs) that are indications for EUS-based assessment of cancer invasion depth.METHODS We retrospectively investigated the cases of 153 EGC patients who underwent conventional endoscopy(CE) and EUS(20 MHz) before treatment.RESULTS We found that 13.7% were "inconclusive" cases with low-quality EUS images, including all nine of the cases with protruded(0-I)-type EGCs. There was no significant difference in the diagnostic accuracybetween CE and EUS. Two significant independent risk factors for misdiagnosis by EUS were identified-ulcer scarring [UL(+); odds ratio(OR) = 4.49, P = 0.003] and non-indication criteria for endoscopic resection(ER)(OR = 3.02, P = 0.03). In the subgroup analysis, 23.1% of the differentiated-type cancers exhibiting SM massive invasion(SM2) invasion(submucosal invasion ≥ 500 μm) by CE were correctly diagnosed by EUS, and 23.1% of the undifferentiated-type EGCs meeting the expanded-indication criteria for ER were correctly diagnosed by EUS.CONCLUSION There is no need to perform EUS for UL(+) EGCs or 0-I-type EGCs, but EUS may enhance the pretreatment staging of differentiated-type EGCs with SM2 invasion without UL or undifferentiated-type EGCs revealed by CE as meeting the expanded-indication criteria for ER.

Comparison of preoperative TN staging of gastric carcinoma by endoscopic ultrasonography with CT examination

IM To assess the accuracy and limitations of endoscopic ultrasonography (EUS) in the preoperative staging of gastric carcinoma in comparison with computed tomography (CT).METHODS According to the new (1987) TN staging, 62 patients with gastric carcinomas were examined preoperatively by EUS and compared with the postoperative pathological TN staging. CT of abdomen was performed before surgery in 32 of the patients.RESULTS The overall accuracy of T staging was 839% for EUS and 281% for CT. For the detection of regional lymph node metastases, EUS accuracy was 790%, sensitivity 800% and specificity 875%, versus 500% accuracy for CT. The coincidence of perigastric infiltration was 900% for EUS and 412% for CT. The most frequent causes of misdiagnosis by EUS were microscopic tumor invasion and peritumorous inflammatory or fibrous changes.CONCLUSION EUS is a reliable method for the clinical evaluation of locoregional extension of gastric cancer and more accurate than CT in the preoperative staging of gastric carcinoma.

Values of endoscopic ultrasonography for diagnosis and treatment of duodenal protruding lesions

Objective： The diagnoses of patients with duodenal protruding lesions are difficult when using conventional examinations such as computed tomography （CT） and conventional endoscope etc. Thus, we investigated the clinical value of endoscopic ultrasonography （PUS） with miniature ultrasonic probes on the diagnosis and treatment of duodenal protruding lesions. Methods： Patients with duodenal protruding lesions who were indicated for PUS were examined by PUS with 12-15 MHz miniature ultrasonic probes and double-cavity electronic endoscope. According to diagnosis of PUS, those patients were indicated for biopsy and treatment received biopsy, endoscopic resection or surgical excision. The postoperative histological results were compared with the preoperative diagnosis of PUS. Those patients without endoscopic resection or surgical excision were periodically followed up with PUS. Results： A total of 169 patients with duodenal protruding lesions were examined by PUS, of which 40 were diagnosed with cysts, 36 with inflammatory protruding or polyp, 25 with Brunner＇s gland adenoma, 19 with ectopic pancreas, 17 with gastrointestinal stromal tumor, 12 with extrinsic compression, 12 with minor papilla, 6 with lipoma, 1 with adenocarcinoma and 1 with lymphoma. After PUS examinations, 75 patients received biopsy, endoscopic resection or surgical excision respectively. The postoperative histological results of 70 patients were completely consistent with the preoperative diagnosis of PUS, with 93.33% diagnostic accuracy. The results of follow-up with PUS indicated that duodenal cyst, Brunner＇s gland adenoma, ectopic pancreas, gastrointestinal stromal tumor and lipoma remained unchanged within 1-3 years. No related complications occurred among all patients that received PUS examinations. Conclusion： PUS is an effective and reliable diagnostic method for duodenal protruding lesions.

Diagnostic evaluation of endoscopic ultrasonography with submucosal saline injection for differentiating between T1a and T1b early gastric cancer

BACKGROUND Endoscopic ultrasonography(EUS)has become a reliable method for predicting the invasion depth of early gastric cancer(EGC).However,diagnostic accuracy of EUS is affected by several factors.In particular,it is difficult to differentiate between T1a and T1b EGC through EUS.AIM To confirm whether submucosal saline injection(SSI)could improve the accuracy of EUS in distinguishing T1a and T1b lesions in EGC.METHODS Twenty-four patients with EGC were examined by EUS and subsequently by SSI combined EUS to compare the degree of tumor invasion.Then,they underwent endoscopic or surgical resection within 7 d.The diagnostic accuracy of EUS and SSI combined EUS was evaluated based on the final pathological findings postoperatively.Saline injected into the submucosa acted as an echoic contrast enhancing agent and had the effect of distinguishing the mucosal and submucosal layers clearly.RESULTS Of total 24 patients,23 were diagnosed with EGC(T1 cancer:13 as T1a,and 10 as T1b).Standard EUS identified 6 of 13 T1a cancer patients and 3 of 10 T1b cancer patients.Whereas,EUS-SSI identified 12 of 13 T1a cancer patients and 6 of 10 T1b cancer patients.In this study,SSI combined EUS was more accurate than EUS alone in diagnosing T1a and T1b lesions of EGC(75.0%and 37.5%,respectively).CONCLUSION SSI improved the diagnostic accuracy of EUS in distinguishing between the T1a and T1b stages in EGC.

The value of endoscopic ultrasonography on diagnosis and treatment of esophageal hamartoma

Objective:To examine the values of endoscopic ultrasonography (EUS) on diagnosis and treatment of esophageal hamartoma. Methods:We compared and analyzed various kinds of imaging examinations such as barium esophagram, con-trast-enhanced computed tomography (CT) and conventional gastroscopy in retrospectively reviewing the clinical data of an esophageal hamartoma patient seen in our clinic in the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. Having received various imaging examinations, this patient was finally diagnosed with esophageal hamartoma and underwent gastroscopic resection of hamartoma with the diagnostic information obtained from EUS. The patient had been regularly followed up for 13 months after treatment. Results: Barium esophagram, CT and conventional gastroscopy detected the lesion, but were unable to distinguish it from common esophagopolypus and other submucosal lesions, and unable to determine etiopathogenisis. EUS detected the hamartoma and identified its internal structure, echo, exact size, depth of invasion, origin and the relationship between adjacent tissues and organs, differentiating the lesion from other submucosal tumors and clearly defining the diagnosis. EUS-guided fine needle aspiration (FNA) also helped to identify the etiological diagnosis. Conclusion: EUS was superior to other imaging means in diagnosis and treatment of hamartoma.

Diagnosis of pancreatic tumors by endoscopic ultrasonography

Pancreatic tumors are highly diverse, as they can be solid or cystic, and benign or malignant. Since their imaging features overlap considerably, it is often difficult to characterize these tumors. In addition, small pancreatic tumors, especially those less than 2 cm in diameter, are difficult to detect and diagnose. For characterizing pancreatic tumors and detecting small pancreatic tumors, endoscopic ultrasonography (EUS) is the most sensitive of the imaging procedures currently available. This technique also provides good results in terms of the preoperative staging of pancreatic tumors. EUS-guided fine needle aspiration (EUS-FNA) has also proved to be a safe and useful method for tissue sampling of pancreatic tumors. Despite these advantages, however, it is still difficult to differentiate between be-nign and malignant, solid or cystic pancreatic tumors, malignant neoplasms, and chronic pancreatitis using EUS, even when EUS-FNA is performed. Recently, contrast-enhanced EUS with Doppler mode (CE-EUS) employing ultrasound contrast agents, which indicate vascularization in pancreatic lesions, has been found to be useful in the differential diagnosis of pancreatic tumors, especially small pancreatic tumors. However, Doppler ultrasonography with contrast-enhancement has several limitations, including blooming artifacts, poor spatial resolution, and low sensitivity to slow flow. Consequently, an echoendoscope was developed recently that has a broad-band transducer and an imaging mode that was designed specifically for contrastenhanced harmonic EUS (CEH-EUS) with a secondgeneration ultrasound contrast agent. The CEH-EUS technique is expected to improve the differential diagnosis of pancreatic disease in the future. This review describes the EUS appearances of common solid and cystic pancreatic masses, the diagnostic accuracy of EUS-FNA, and the relative efficacies and advantages of CE-EUS and CEH-EUS along with their relative advantages and their complementary roles in clinical practice.

Comprehensive review on EUS-guided biliary drainage

Feasibility of endoscopic retrograde cholangiopancreatography(ERCP) for biliary drainage is not always applicable due to anatomical alterations or to inability to access the papilla. Percutaneous transhepatic biliary drainage has always been considered the only alternative for this indication. However,endoscopic ultrasonography-guided biliary drainage represents a valid option to replace percutaneous transhepatic biliary drainage when ERCP fails. According to the access site to the biliary tree,two kinds of approaches may be described: the intrahepatic and the extrahepatic. Endoscopic ultrasonography-guided rendezvous transpapillary drainage is performed where the second portion of the duodenum is easily reached but conventional ERCP fails. The recent introduction of self-expandable metal stents and lumen-apposing metal stents has improved this field. However,the role of the latter is still controversial. Echoendoscopic transmural biliary drainage can be challenging with potential severe adverse events. Therefore,trained endoscopists,in both ERCP and endoscopic ultrasonography are needed with surgical and radiological backup.

CT、MRCP和EUS对胆总管结石的诊断价值研究

目的探讨CT、磁共振胰胆管造影(MRCP)及超声内镜(EUS)对胆总管结石的诊断价值。方法收集来我院就诊的疑似胆总管结石患者的临床资料258份,进行回顾性分析,根据入院后首次检查方法将患者分为CT组、MRCP组及EUS组,三组分别为95例、91例及72例,以内镜逆行胰胆管造影(ERCP)结果为金标准,比较三组的灵敏度、特异度及准确度。结果三组灵敏度比较,EUS组高于其它两组,CT组最低(P<0.05);准确度比较,EUS组高于其它组,CT组最低(P<0.05);特异度比较,EUS组与MRCP组均高于CT组(P<0.05),但EUS组与MRCP组无差异(P>0.05)。结论对于胆总管结石的诊断,EUS和MRCP的诊断价值要比CT好,EUS的灵敏度及准确度高于MRCP。

超声测量与胃镜实测摄入导泻液后胃内容量的时间-容量关系及一致性分析

目的通过超声评估结合胃镜抽吸研究患者饮用导泻液后胃内容量的变化并比较两种测量方法的一致性。方法选择按照2 L聚乙二醇(PEG)方案饮用导泻液的非插管全麻下胃肠镜检查患者205例,男108例,女97例,年龄18~75岁,BMI 18.5~30.0 kg/m^(2),ASAⅠ或Ⅱ级,按照禁饮时间随机分为五组:2 h~2 h 25 min组(2 h组,n=40)、2 h 30 min~2 h 55 min组(2.5 h组,n=42)、3 h~3 h 25 min组(3 h组,n=41)、3 h 30 min~3 h 55 min组(3.5 h组,n=41)、4 h~4 h 25 min组(4 h组,n=41)。麻醉前使用超声测量患者胃窦横截面积(CSA)并用Perlas公式计算胃内容量,随后在胃镜检查时抽吸胃内液体获得实测胃内容量。观察胃内容量随禁饮时间的变化,采用Spearman检验分析两者的相关性,并采用Bland-Altman检验分析超声评估胃内容量与实测胃内容量的一致性。结果五组超声评估胃内容量以及实测胃内容量差异均无统计学意义,实测胃内容量与禁饮时间之间无明显相关(P=0.729,r=-0.031,95%CI-0.167~0.106)。Perlas公式计算值与实测值的平均误差为37.7 ml(95%CI 33.8~41.7 ml),95%一致性界限为-18.0~94.0 ml,计算值明显高于实测值(P<0.05)。结论在饮用完2 L导泻液后的2 h~4 h 25 min,胃内容量并不随禁饮时间缩短而增加。Perlas公式计算的超声测量胃内容量明显高于实际测量的胃内容量。

高频超声及超声造影引导内镜治疗小儿粪石所致化脓性阑尾炎的临床价值

目的探讨高频超声及术中腔内超声造影引导内镜下逆行阑尾炎治疗术(ERAT)联合数字化胆道子镜(以下简称子镜)治疗小儿粪石所致化脓性阑尾炎的临床价值。方法回顾性分析行内镜治疗的48例粪石所致化脓性阑尾炎患儿的病历资料,所有患儿术前均行高频超声检查测量阑尾外径、阑尾壁厚度、粪石直径,观察其周边网膜是否增厚,术中腔内超声造影观察并记录粪石是否成功取出、阑尾有无穿孔。根据术后治疗结果分为取石成功组39例和术中穿孔组9例,分析超声与子镜检查结果的诊断符合率;记录并发症发生情况。治疗后定期随访患儿,比较两组超声参数、实验室指标恢复正常时间和临床症状消失时间及疗效。结果48例患儿术中腔内超声造影显示粪石成功清除39例,阑尾穿孔9例;子镜显示粪石成功清除34例,阑尾破口5例,二者诊断符合率分别为87.17%、55.56%。术后取石成功组均未见明显并发症,术中穿孔组出现1例阑尾周围包裹性脓肿。治疗后两组阑尾壁厚度、网膜厚度、白细胞计数、C反应蛋白恢复正常参考值时间和腹痛、发热消失时间比较,差异均有统计学意义(均P<0.05)。取石成功组疗效为优、良、差者分别为35、4、0例,术中穿孔组疗效为优、良、差者分别为0、8、1例,两组治疗优良率比较(100%vs.88.89%),差异无统计学意义。结论高频超声及术中腔内超声造影引导ERAT联合子镜治疗小儿粪石所致化脓性阑尾炎具有实时、精准、治愈率高且并发症少的优势,有一定的临床价值。

细胞角蛋白19片段、蛋白激酶B和糖类抗原19-9水平联合超声内镜检查术对胃肠道间质瘤的鉴别价值

目的分析细胞角蛋白19片段(CYFRA21-1)、蛋白激酶B(PKB)和糖类抗原19-9(CA19-9)水平联合超声内镜检查术(EUS)对胃肠道间质瘤和非胃肠道间质瘤的鉴别价值。方法前瞻性纳入2020年1月-2023年7月该院收治的69例胃肠道间质瘤患者作为研究组,另择同期78例非胃肠道间质瘤患者(胃肠道平滑肌瘤25例,胃肠道神经鞘瘤53例)作为对照组。比较两组患者一般资料、EUS指标和肿瘤标志物,绘制受试者操作特征曲线(ROC curve),分析血清CYFRA21-1、PKB和CA19-9水平单独检测,以及联合EUS,对胃肠道间质瘤的诊断价值。结果与对照组比较,研究组灰度平均值、灰度标准偏差、血清CYFRA21-1、PKB和CA19-9水平更高(P<0.05)。不同性别和年龄的胃肠道间质瘤患者,灰度平均值、灰度标准偏差、血清CYFRA21-1、PKB和CA19-9水平比较,差异均无统计学意义(P>0.05)。与肿瘤直径≤5 cm、病理性核分裂象≤5个/50 HPF的胃肠道间质瘤患者比较,肿瘤直径>5 cm、病理性核分裂象>5个/50 HPF的胃肠道间质瘤患者,灰度平均值、灰度标准偏差、血清CYFRA21-1、PKB和CA19-9水平更高(P<0.05)。将胃肠道间质瘤纳入阳性,非胃肠道间质瘤纳入阴性,ROC curve显示,联合检测胃肠道间质瘤的诊断价值高于EUS、血清CYFRA21-1、PKB和CA19-9水平单独检测,曲线下面积(AUC)为0.936,敏感度为82.61%,特异度为91.03%。结论在胃肠道间质瘤中,CYFRA21-1、PKB、CA19-9水平、灰度平均值和灰度标准偏差升高,CYFRA21-1、PKB和CA19-9水平联合EUS在胃肠道间质瘤中诊断价值较高。

超声内镜检查术联合血清丝氨酸蛋白酶抑制剂Kazal 1型和分泌型磷蛋白1对食管癌的早期诊断价值

目的探讨超声内镜检查术(EUS)联合血清丝氨酸蛋白酶抑制剂Kazal 1型(SPINK1)和分泌型磷蛋白1(SPP1)早期诊断食管癌的临床价值。方法选取2021年6月-2023年5月于该院就诊的276例患者作为研究对象。经手术病理诊断为食管癌92例,作为食管癌组,同期收治且经组织活检判定为食管良性病变89例,作为良性病变组,同期在该院体检且身体健康的95例正常人,作为健康对照组。以病理结果为金标准,验证EUS诊断食管癌的准确率;比较3组患者血清SPINK1和SPP1表达情况;探讨食管癌患者血清SPINK1和SPP1表达与病理特征的关系;采用受试者操作特征曲线(ROC curve)分析EUS联合血清SPINK1和SPP1水平检测对食管癌的早期诊断效能。结果EUS结果显示,81例被诊断为食管癌,79例被诊断为良性病变,11例漏诊,10例误诊,准确率为88.40%(160/181);与健康对照组和良性病变组比较,食管癌组血清SPINK1和SPP1表达水平明显升高,良性病变组血清SPINK1和SPP1表达水平明显高于健康对照组,差异均有统计学意义(P<0.05);血清SPINK1表达与患者肿瘤直径>2 cm、淋巴结转移、淋巴结阳性和组织分级为Ⅲ级有关(P<0.05),血清SPP1表达水平与肿瘤直径>2 cm、淋巴结转移、淋巴结阳性和雌激素受体阳性有关(P<0.05);ROC curve显示,EUS、血清SPINK1、SPP1水平单独检测和三者联合检测,早期诊断食管癌的曲线下面积(AUC)分别为0.862,0.834,0.782和0.926,三者联合早期诊断食管癌的临床效能明显优于EUS、血清SPINK1和SPP1单独检测(Z=2.30、Z=3.70、Z=4.23,P=0.022、P=0.000、P=0.000)。结论食管癌患者血清SPINK1和SPP1表达均异常上调,EUS联合血清SPINK1和SPP1表达水平联合检测用于早期诊断食管癌,具有较高的临床应用价值。

上消化道间质瘤的内镜及病理学特点分析

目的探讨上消化道间质瘤(GIST)的胃镜、超声内镜及病理学特点。方法回顾分析该院2005年7月～2007年7月诊断的43例上消化道GIST的内镜及病理学资料。结果43例GIST中18例经胃镜加病理活检及免疫组织化学法确诊,胃镜下表现为球形或半球形黏膜下隆起,可有脐样溃疡;病理学上GIST细胞以梭形或上皮样细胞为主,成束状排列,免疫组织化学法示CD117,CD34表达阳性率分别为100%及89%,平滑肌肌动蛋白(SMA)及突触素(SYN)无表达;余23例经超声内镜诊断,良性20例,恶性3例,表现为起源于固有肌层的均质或不均质低回声。结论GIST的诊断有赖于胃镜、超声内镜与病理活检、免疫组织化学法相结合。

食管黏膜下肿瘤的超声内镜诊断与内镜下微创治疗

目的评价超声内镜对食管黏膜下肿瘤的诊断及治疗价值,探讨内镜微创治疗食管黏膜下肿瘤的有效性和安全性。方法经胃镜和超声内镜检查后诊断为起源于食管黏膜肌层肿瘤患者54例,直径≤1.0 cm的采用内镜下高频电圈套切除术,直径>1.0 cm的采用内镜黏膜下剥离术切除肿瘤。结果 54例患者均完全切除。病理组织学显示食管平滑肌瘤48例,淋巴管瘤3例,囊肿1例,均来源于黏膜肌层,间质瘤2例来源于固有肌层。1例术中发生创面出血,经高频电凝止血立刻停止,未发生其他与手术相关的并发症。术后6个月随访,所有患者创面均形成白色溃疡瘢痕。结论超声内镜辅助下内镜微创手术切除来源于黏膜肌层的食管黏膜下肿瘤是安全有效的治疗方法。

消化道黏膜下肿物的内镜及超声内镜下特点分析

目的探讨消化道黏膜下肿物的内镜及超声内镜下特点。方法对153例消化道黏膜下肿物进行内镜及超声内镜检查,最终经病理学及免疫组化明确诊断。结果确诊消化道平滑肌瘤51例、胃肠道间质瘤37例、脂肪瘤30例、类癌21例、异位胰腺7例、神经鞘瘤3例、错构瘤3例和血管球瘤1例。超声内镜对平滑肌瘤、间质瘤、脂肪瘤、类癌、异位胰腺、神经鞘瘤、错构瘤和血管球瘤的诊断符合率分别为92%、92%、100%、71%、71%、0、0和100%,其总诊断符合率为86%,明显高于内镜总诊断符合率(70%)。结论超声内镜可明确消化道黏膜下肿物的大小、起源、回声、生长方式,对消化道黏膜下肿物的诊断及鉴别诊断有重要作用。

术中超声联合内镜技术治疗自发性脑内血肿经验初探

目的评价采用术中超声联合内镜技术治疗自发性脑内血肿的临床应用价值。方法2016年10月至2019年10月解放军总医院第一医学中心和海南医院神经外科共对17例自发性脑出血患者实施超声引导内镜下脑内血肿清除术,术中采用超声诊断仪定位血肿位置、反馈血肿清除程度;术后计算血肿清除率并记录超声和内镜相关并发症或不良事件,采用Karnofsky功能状态评分(KPS)评价神经功能改善程度。结果17例患者手术成功率达100%,且无一例发生与超声或内镜相关并发症或不良事件;所有患者均在超声引导下将内镜工作通道一次性准确置入血肿中心。17例患者术前血肿量中位值为44.40(31.20,54.35)ml、术后3.00(1.80,5.10)ml,血肿清除率约94.01%(87.11,96.08)%;术前KPS评分中位评分为20(15,30)、术后2周中位评分为40(35,50),较术前明显改善(Z=⁃3.671,P=0.000)。结论术中超声联合内镜技术治疗自发性脑内血肿安全、可行,该项联合技术有助于准确定位血肿、提高血肿清除率、减少并发症和促进神经功能恢复。