超声内镜检查术诊断消化道黏膜下病变的回顾性分析

Retrospective analysis of endoscopic ultrasonography in diagnosis of digestive tract submucosal lesions

摘要:

目的 评估超声内镜检查术（EUS）诊断消化道黏膜下病变（SML）的临床价值。方法 回顾性分析2020年1月－2021年12月该院消化内科使用EUS诊断，并经组织病理学证实为SML患者的病例资料。结果 共有142例消化道SML患者进行了EUS检查。其中，135例为实体瘤，7例为壁外压迫。实体瘤中，EUS诊断黏膜层病变14例，黏膜肌层病变20例，黏膜下层病变62例，固有肌层病变39例，其诊断准确率分别为：100.0%、100.0%、95.0%和89.7%。EUS诊断平滑肌瘤30例（21.1%），间质瘤29例（20.4%），神经内分泌肿瘤25例（17.6%），异位胰腺15例（10.6%），息肉14例（9.9%），脂肪瘤11例（7.7%），囊肿9例（6.3%），壁外压迫7例（4.9%），颗粒细胞瘤2例（1.4%）。107例行内镜治疗或手术切除后送病检，99例病理与EUS诊断相符，EUS总体诊断准确率为92.5%。结论 EUS对消化道SML诊断的准确性与病变的起源有关，起源于黏膜层与黏膜肌层的诊断准确性最高，在鉴别壁内病变与壁外压迫方面，也具有较好的诊断价值。EUS在一定程度上可以判断SML的性质，有助于确定病变的治疗方式。

Abstract:

Objective To evaluate the clinical value of endoscopic ultrasonography (EUS) in diagnosis of digestive tract submucosal lesions (SML).Methods This was a retrospective study involving patients diagnosed with SML using EUS and confirmed by histopathology from January 2020 to December 2021.Results 142 patients with SML were examined by EUS. There were 135 solid tumors and 7 extramural compression. In solid tumors, 14 cases of mucosal lesions, 20 cases of mucosal muscular lesions, 62 cases of submucosal lesions, and 39 cases of muscularis propria lesions were diagnosed by EUS. The accuracy of EUS lamellar diagnosis respectively was 100.0%, 100.0%, 95.0%, and 89.7%. 30 cases of leiomyoma (21.1%), 29 cases of mesenchymal tumor (20.4%), 25 cases of neuroendocrine tumor (17.6%), 15 cases of ectopic pancreas (10.6%), 14 cases of polyp (9.9%), 11 cases of lipoma (7.7%), 9 cases of cyst (6.3%), 7 cases of extramural compression (4.9%), 2 cases of granular cell tumor (1.4%) were diagnosed by EUS. 107 patients underwent endoscopic treatment or surgical resection, and 99 cases were pathologically consistent with EUS diagnosis. The overall diagnostic accuracy of EUS was about 92.5%.Conclusion The diagnostic accuracy of endoscopic ultrasonography for submucosal lesions is related to the origin of lesions, and the mucosal and mucosal muscularity have the highest diagnostic accuracy. EUS also has good diagnostic value in differentiating intramural lesions from extramural compression. EUS can determine the nature of SML to a certain extent and help to determine the treatment of lesions.