上消化道外压和黏膜下病变的临床病理及超声内镜特征

Clinicopathological and endoscopic ultrasound features of submucosal lesions and upper gastrointestinal tract

摘要:

目的 探讨上消化道外压和黏膜下病变（SML）的临床病理及超声内镜（EUS）特征，为内镜医师诊断此类病变提供依据。方法 回顾性分析2008年12月－2020年12月在该院行胃镜检查，提示存在上消化道隆起性改变的147例患者的临床资料，分析其临床病理及EUS特征。结果 共纳入上消化道外压70例，SML 77例。外压性改变中，食道外压27例，多见于主动脉（20例）和淋巴结（5例）；胃外压36例，多见于脾脏（7例）、胰头癌（4例）、胰腺（4例）、胆囊（4例）和横结肠（4例）；十二指肠外压7例，多见于胰头癌（3例）和胆囊（2例）。SML中，食道SML 49例，以平滑肌瘤（34例）和囊肿（11例）为主；胃SML 23例，以异位胰腺（9例）、脂肪瘤（6例）和胃肠道间质瘤（5例）为主；十二指肠SML 5例，以囊肿（3例）为主。结论 食道外压多见于主动脉和淋巴结，食道SML以平滑肌瘤和囊肿为主。胃外压多见于脾脏、胰头癌、胰腺、胆囊和横结肠，胃SML以异位胰腺、脂肪瘤和胃肠道间质瘤为主。十二指肠外压多见于胰头癌和胆囊，十二指肠SML以囊肿为主。

Abstract:

Objective We explored the clinicopathological and endoscopic ultrasonography (EUS) features of submucosal lesions (SML) and the upper gastrointestinal tract, with the aim of improving diagnostic performance for similar lesions.Methods Retrospective analysis was made on the clinical data of 147 patients from December 2008 to December 2020 and shown the presence of upper digestive tract uplifting changes by gastroscopy, the clinicopathological and EUS characteristics were analyzed.Results In total, 70 extraluminal compression cases and 77 SML cases were included. Among the 27 extraluminal compression cases in the esophagus, compressions by aorta (20 cases) and lymph nodes (5 cases) were in the majority. Among the 36 extraluminal compression cases in the stomach, compressions by spleens (7 cases), pancreatic head malignancies (4 cases), pancreases (4 cases), gallbladders (4 cases) and transverse colons (4 cases) were the most common. Among the 7 extraluminal compression cases in the duodenum, compressions by pancreatic head malignancies (3 cases) and gallbladders (2 cases) were the most popular. Among the 49 esophageal SMLs, leiomyomas (34 cases) and cysts (11 cases) were in the majority. Among the 23 gastric SMLs, ectopic pancreases (9 cases), ipomas (6 cases) and gastrointestinal stromal tumors (5 cases) were in the majority. Among the 5 duodenal SMLs, cysts were in the majority (3 cases).Conclusion Aorta and lymph node are most common causes of compressions in the esophagus, then leiomyoma and cyst are in the majority of esophageal SMLs. Spleen, pancreatic head malignancy, gallbladder, pancreas, and transverse colon are the most common causes of compressions in the stomach, then ectopic pancreas, lipoma, and gastrointestinal stromal tumor are in the majority of gastric SMLs. Pancreatic head malignancy and gallbladder are most common causes of compressions in the duodenum, then cyst is in the majority of duodenal SMLs.