超声内镜对结直肠黏膜下病变的诊断价值*

Endoscopic ultrasonography (EUS) in diagnosis of colorectal submucosal lesions*

摘要:

目的??探讨超声内镜（EUS）在结直肠黏膜下病变诊断和治疗中的作用。方法?对结直肠黏膜下病变进行EUS检查。根据黏膜下病灶的起源层次，部分患者接受深挖活检、超声内镜引导下细针穿刺吸取活检术（EUS-FNA）、内镜下治疗或外科手术。回顾性分析EUS诊断结果与临床病理的相关性。结果?EUS检查的74例患者中，诊断神经内分泌肿瘤28例（均位于直肠）；脂肪瘤15例（其中位于回盲部4例、横结肠1例、升结肠8例、乙状结肠2例）；直肠间质瘤2例（固有肌层和黏膜肌层各1例）；外压性改变14例（卵巢肿瘤9例，淋巴结2例，盆腔肿瘤3例）；囊肿5例（横结肠4例、升结肠1例）；气囊肿1例；乙状结肠子宫内膜异位3例；直肠周边恶性肿瘤侵犯4例；肠道淋巴瘤2例。所有病灶均接受深挖活检、EUS-FNA、内镜下治疗或外科手术。最终病理和EUS诊断符合率为68/74（91.9%），其中2例EUS考虑直肠类癌最后病理确诊为黏膜肌层来源的平滑肌瘤。1例考虑脂肪瘤最终确诊为肠道淋巴瘤。2例考虑直肠周边恶性肿瘤最终为炎性包块，1例考虑子宫内膜异位症最终诊断为直肠癌。结论?EUS能清晰地显示消化道各层结构，能清楚显示结直肠黏膜下病变的大小、起源及其与相邻结构的关系，并且能较精确地判断各种病变的性质，进而指导结直肠黏膜下病变的治疗。

Abstract:

Objective?To investigate the role of endoscopic ultrasonography (EUS) in diagnosis and treatment of colorectal submucosal lesions.?Methods?EUS were applied in 74 patients with suspected colorectal submucosal lesions. According to the origin of submucosal lesion, the patients had received biopsy, endoscopic ultrasonography-fine needle aspiration (EUS-FNA) and endoscopic treatment or surgery. The correlation between EUS and clinical pathology is analyzed retrospectively.?Results?In the diagnosis based on EUS, there were 28 cases of neuroendocrine tumors (occurred in the rectum), 15 lipomas (4 cases occurred in ileocecal, 1 in transverse colon, 8 in ascending colon, 2 in sigmoid colon), 2 rectal gastrointestinal stromal tumor (1 in muscularis propria and the other in muscularis mucosa), 14 external pressure changes (9 ovarian tumor, 2 lymph nodes, 3 pelvic tumor), 5 cyst (4 in transverse colon, 1 in ascending colon), 1 gas cyst, 3 sigmoid colon endometriosis, 4 rectum malignant tumor invasion, 2 intestinal lymphoma. All the patients had received biopsy, EUS-FNA, endoscopic treatment or surgery. Compared with pathology, a total coincidence rate of 91.9% (68/74) was achieved by EUS, and 2 cases were pathologically diagnosed as leiomyoma, which is considered as rectal carcinoma by EUS at first, 1 case of intestinal lymphoma instead of lipoma, 2 inflammatory mass instead of malignant tumor around the rectum, and 1 rectal carcinoma instead of endometriosis.?Conclusion?The digestive tract structure could be showed clearly with EUS, and the size of the colon and rectal submucosal lesions, the layer of origin and the structural relationship of adjacent tissues could also be detected. Then, the appropriate treatment against the colon and rectal submucosal lesions would be adopted after the accurate judgment of lesions with EUS.