發(fā)布時(shí)間：2018-04-23 05:09

  本文選題：超聲內(nèi)鏡 + 上消化道隆起性病變　； 參考：《皖南醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：探討超聲內(nèi)鏡（endoscopic ultrasonography，EUS）在上消化道隆起性病變的診斷和治療中的應(yīng)用價(jià)值，為臨床診療提供依據(jù)。 方法：收集2011年1月～2012年12月在弋磯山醫(yī)院消化內(nèi)鏡中心行胃鏡及超聲內(nèi)鏡檢查發(fā)現(xiàn)的上消化道隆起性病變507例，對(duì)其中275例患者行活組織檢查、EUS-FNA、內(nèi)鏡下切除或手術(shù)切除獲得病理診斷者納入本項(xiàng)目研究，比較超聲內(nèi)鏡與電子胃鏡診斷符合率；并對(duì)其中166例患者進(jìn)一步行CT檢查，比較超聲內(nèi)鏡與CT診斷符合率；分析超聲內(nèi)鏡給出相應(yīng)診斷的聲像圖特點(diǎn)，與病理結(jié)果作對(duì)比，從而歸納出相關(guān)病變的超聲聲像圖特征及特點(diǎn)；統(tǒng)計(jì)按EUS診斷結(jié)果行內(nèi)鏡下治療或手術(shù)治療患者的治愈率與并發(fā)癥發(fā)生率，進(jìn)一步評(píng)價(jià)超聲內(nèi)鏡對(duì)上消化道隆起性病變治療方式選擇的指導(dǎo)意義。 結(jié)果：1、超聲內(nèi)鏡對(duì)上消化道隆起性病變的診斷符合率為88．0%（242/275例），胃鏡診斷符合率為57.8%（159/275例），兩者診斷一致的符合率為53.5%（147/275例），兩者之間的比較應(yīng)用配對(duì)χ2檢驗(yàn)，P＜0．01，差異有統(tǒng)計(jì)學(xué)意義；2、其中，166例患者完成上腹部或胸部CT檢查， CT診診斷符合率為45.2%（75/166例），超聲內(nèi)鏡診斷符合率為87.3%（145/166例），兩者診斷一致的符合率為39.2%（65/166例），兩者之間的比較應(yīng)用配對(duì)χ2檢驗(yàn)，P 0．05，差異有統(tǒng)計(jì)學(xué)意義。2、超聲內(nèi)鏡聲像特征為：平滑肌瘤表現(xiàn)為均勻低回聲，，間質(zhì)瘤表現(xiàn)為不均勻的低回聲，異位胰腺表現(xiàn)為中低回聲影，囊腫表現(xiàn)為無(wú)回聲，脂肪瘤表現(xiàn)為高或強(qiáng)回聲，癌表現(xiàn)為稍低回聲。3、275例患者，分別行內(nèi)鏡下切除或手術(shù)切除，治愈率為98.2％。并發(fā)癥發(fā)生率為2.5％。 結(jié)論：1、EUS對(duì)上消化道隆起性病變的診斷有較高的準(zhǔn)確率；2、EUS對(duì)上消化道隆起性病變的診斷的準(zhǔn)確率明顯高于胃鏡及CT,對(duì)于上消化道隆起病變應(yīng)首選EUS檢查。3、EUS檢查病變的聲像圖特征可以為上消化道隆起性病變的診斷提供較高的價(jià)值。4、EUS檢查對(duì)上消化道隆起性病變治療方式的選擇具有重要的指導(dǎo)意義。
[Abstract]:Objective: to evaluate the value of endoscopic ultrasonography (EUS) in the diagnosis and treatment of upper digestive tract protuberance lesions, and to provide basis for clinical diagnosis and treatment. Methods: from January 2011 to December 2012, 507 cases of upper digestive tract protuberance were examined by endoscopy and gastroscopy in the Center of Digestive Endoscopy in the Gastrointestinal Hospital. Two hundred and seventy-five patients were examined with EUS-FNA.Endoscopic resection or surgical resection for pathological diagnosis was included in the study to compare the diagnostic coincidence rate between endoscopic ultrasonography and electronic gastroscopy, and further CT examination was performed in 166 of them. To compare the coincidence rate of ultrasound endoscopy and CT diagnosis, to analyze the characteristics of ultrasonic image of the corresponding diagnosis, and to compare with the pathological results, so as to sum up the characteristics and characteristics of the ultrasonic image of the related lesions. According to the results of EUS diagnosis, the cure rate and complication rate of patients undergoing endoscopic or surgical treatment were statistically analyzed, and the guiding significance of EUS in the treatment of upper digestive tract protruding lesions was further evaluated. Results the coincidence rate of endoscopic ultrasonography in diagnosis of upper digestive tract protuberance lesions was 88.0 / 242 / 275, gastroscopy was 57.8 / 159 / 275, and the coincidence rate of diagnosis was 53.557 / 275 respectively. The comparison between the two was performed with 蠂 ~ 2 test (P < 0.01), and the difference was significant (P < 0.01). There were 166 cases of upper abdomen or chest CT examination, the coincidence rate of CT diagnosis was 45.2275 / 166 cases, the accuracy rate of endoscopic ultrasonography diagnosis was 87.3% and 145 / 166 cases, the coincidence rate of the two diagnosis was 39.22um / 65166 cases. The comparison between the two cases should be carried out. The pairing 蠂 2 test showed that the difference was statistically significant (P 0.05). The characteristics of endoscopic ultrasonography were as follows: leiomyoma showed homogenous hypoechoic. Stromal tumors showed heterogeneous hypoechoic findings, ectopic pancreas showed low echo, cyst showed anechoic, lipoma showed hyperechoic or hyperechoic, cancer showed slightly hypoechoic. 3275 patients underwent endoscopic resection or surgical resection. The cure rate was 98.2%. The incidence of complications was 2.5. Conclusion the diagnostic accuracy of EUS in the diagnosis of upper digestive tract protuberance lesions is higher than that of gastroscopy and CT.EUS should be selected as the first choice for the diagnosis of upper digestive tract protuberance lesions. 3% EUS is the first choice for the diagnosis of upper digestive tract protuberance lesions. The sonographic features of EUS can provide a high value for the diagnosis of upper digestive tract protuberance lesions. EUS examination has important guiding significance for the choice of treatment methods for upper digestive tract protuberance lesions.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1;R54

【參考文獻(xiàn)】

相關(guān)期刊論文 前6條

1 吉效東;王志寧;夏揚(yáng);王德軍;石美;;139例消化道支架置入術(shù)的臨床觀察[J];臨床腫瘤學(xué)雜志;2010年01期

2 何遠(yuǎn)琴;王錦萍;趙志清;鄭可國(guó);崔毅;;超聲內(nèi)鏡和螺旋CT檢查對(duì)胃癌術(shù)前TNM分期的比較研究[J];中國(guó)消化內(nèi)鏡;2008年07期

3 楊愛明,陸星華,魯重美,劉文平,劉沙,張明;超聲內(nèi)鏡在上消化道粘膜下腫瘤診斷中的應(yīng)用[J];中華消化內(nèi)鏡雜志;2000年03期

4 李兆申,宛新建,許國(guó)銘,王雯,鄭清渝,滿曉華;食管支架術(shù)后再狹窄的病理學(xué)分析[J];中華消化內(nèi)鏡雜志;2000年04期

5 Mitsuhiro Fujishiro;;Perspective on the practical indications of endoscopic submucosal dissection of gastrointestinal neoplasms[J];World Journal of Gastroenterology;2008年27期

6 姚禮慶;時(shí)強(qiáng);鐘蕓詩(shī);;雙鏡聯(lián)合治療在結(jié)直腸疾病中的應(yīng)用[J];中華臨床醫(yī)師雜志(電子版);2012年21期

本文編號(hào)：1790580