【摘要】：背景:消化道隆起性病變(gastrointestinal eminent lesion)是一類表現(xiàn)為消化道粘膜下隆起或消化道管壁增厚的疾病的統(tǒng)稱。超聲內(nèi)鏡是目前診斷消化道病變及消化道周圍臟器病變的重要診斷方法,對(duì)消化道隆起性病變可提供豐富的影像學(xué)診斷信息。而微探頭超聲內(nèi)鏡作為超聲內(nèi)鏡的一種類型,其優(yōu)點(diǎn)是:操作方便,檢查與治療同步完成,減少患者多次進(jìn)出內(nèi)鏡的痛苦。目的:本課題研究微型探頭超聲內(nèi)鏡(mEUS)檢查術(shù)診斷消化道隆起性病變的診斷準(zhǔn)確率,總結(jié)探討消化道隆起性病變?cè)趍EUS診斷中的超聲圖像特點(diǎn),從而全面評(píng)價(jià)微探頭超聲內(nèi)鏡對(duì)消化道隆起性病變的診斷能力。方法:回顧性分析2011年11月至2015年12月行微探頭超聲內(nèi)鏡檢查術(shù)檢查消化道隆起性病例302例,所有病例診斷結(jié)果均經(jīng)內(nèi)鏡病理,手術(shù)病理或隨訪確診,比較微探頭超聲內(nèi)鏡檢查結(jié)果及傳統(tǒng)內(nèi)鏡檢查結(jié)果的診斷準(zhǔn)確率,數(shù)據(jù)采用SPSS13.0統(tǒng)計(jì)學(xué)處理,計(jì)數(shù)資料采用百分率及構(gòu)成比描述,組間率比較采用χ2檢驗(yàn),以P0.05為有統(tǒng)計(jì)學(xué)意義。結(jié)果:共有302例患者行微型探頭超聲內(nèi)鏡檢查術(shù),其中上消化道274例,結(jié)直腸28例,上消化道中食管97例,胃152例,十二指腸25例。食管隆起性病變mEUS診斷符合率為97.93%(95/97),胃鏡診斷符合率為68.04(66/97)。食管隆起性病變97例中平滑肌瘤/間質(zhì)瘤42例,脂肪瘤7例,囊腫10例,孤立性食管靜脈瘤25例,外壓性隆起13例。胃內(nèi)隆起性病變mEUS診斷符合率為94.07%(143/152),胃鏡診斷符合率為50.65%(77/152)。胃內(nèi)隆起性病變共152例,其中胃粘膜增厚性病變15例,包括皮革胃1例、淋巴瘤5例、胃底靜脈曲張7例、淋巴細(xì)胞性胃炎1例、蔓狀血管瘤1例。胃粘膜下隆起性病變137例,包括胃壁外壓迫性隆起36例、神經(jīng)內(nèi)分泌腫瘤1例、異位胰腺13例、間質(zhì)瘤/平滑肌瘤75例、血管瘤4例、囊腫4例、纖維瘤1例、脂肪瘤2例、胃肝樣腺癌1例。十二指腸隆起性病變mEUS診斷符合率為88%(22/25)),胃鏡診斷符合率為68%(17/25)。十二指腸隆起性病變25例中,包括十二指腸脂肪瘤1例、十二指腸間質(zhì)瘤4例、十二指腸外壓性隆起8例、十二指腸囊腫6例、十二指腸神經(jīng)內(nèi)分泌腫瘤1例、十二指腸布氏腺瘤1例、十二指腸異位胰腺4例。結(jié)直腸性病變mEUS診斷符合率為92.85%(26/28),腸鏡診斷符合率為57.14%(16/28)。結(jié)直腸隆起性病變共28例,包括結(jié)直腸神經(jīng)內(nèi)分泌腫瘤3例、結(jié)直腸脂肪瘤5例、結(jié)直腸間質(zhì)瘤/平滑肌瘤4例、結(jié)直腸子宮內(nèi)膜異位1例、結(jié)直腸囊腫4例、結(jié)直腸氣囊腫3例、外壓性隆起6例、結(jié)直腸淋巴瘤2例。結(jié)論:微探頭超聲內(nèi)鏡能清晰的顯示消化道管壁各層結(jié)構(gòu),反映病變的起源層次及浸潤(rùn)深度,因此其能對(duì)大多數(shù)消化道隆起性病變做出準(zhǔn)確診斷。
[Abstract]:Background: (gastrointestinal eminent lesion) is a common term for submucous eminence of digestive tract or thickening of digestive tract wall. Ultrasound endoscopy is an important method for the diagnosis of digestive tract diseases and perialimentary organ diseases, which can provide abundant imaging diagnosis information for digestive tract protuberance lesions. As a type of endoscopic ultrasound, microprobe ultrasound endoscopy has the advantages of convenient operation, simultaneous examination and treatment, and less pain of patients entering and leaving the endoscope many times. Objective: to study the diagnostic accuracy of microprobe endoscopic (mEUS) in the diagnosis of digestive tract protuberance lesions, and to summarize the characteristics of ultrasound images in the diagnosis of digestive tract protuberance lesions in mEUS. Therefore, the diagnostic ability of microprobe endoscopy for digestive tract protuberance was evaluated. Methods: from November 2011 to December 2015, 302 cases of digestive tract protuberance were examined by microprobe endoscopic ultrasonography. All cases were diagnosed by endoscopic pathology, surgical pathology or follow-up. The diagnostic accuracy of microprobe ultrasound endoscopy and traditional endoscopic examination were compared. The data were processed by SPSS13.0 statistics, the counting data were described by percentage and composition ratio, and the rate between groups was analyzed by 蠂 ~ 2 test, with P0.05 as the statistical significance. Results: a total of 302 patients underwent endoscopic microprobe ultrasonography, including 274 cases of upper digestive tract, 28 cases of colorectal cancer, 97 cases of upper digestive tract esophagus, 152 cases of stomach and 25 cases of duodenum. The coincidence rate of mEUS and gastroscopy was 97.93% (95 / 97) and 68.04 (66 / 97) respectively. There were 42 leiomyoma / stromal tumors, 7 lipomas, 10 cysts, 25 solitary esophageal vein tumors and 13 external compression protuberances. The coincidence rate of mEUS and gastroscopy was 94.07% (143 / 152) and 50.65% (77 / 152) respectively. There were 152 cases of intragastric protruding lesions, including 15 cases of thickening lesions of gastric mucosa, including 1 case of leather stomach, 5 cases of lymphoma, 7 cases of varicose gastric fundus, 1 case of lymphocytic gastritis and 1 case of hemangioma. There were 137 cases of submucosal protruding lesions, including 36 cases of extragastric compression, 1 case of neuroendocrine tumor, 13 cases of ectopic pancreas, 75 cases of stromal tumor / leiomyoma, 4 cases of hemangioma, 4 cases of cyst, 1 case of fibroma and 2 cases of lipoma. One case of gastric hepatoid adenocarcinoma. The diagnostic coincidence rate of mEUS was 88% (22 / 25),) for duodenal protruding lesions (68% (17 / 25). Among 25 cases of duodenal protuberance lesions, including 1 case of duodenal lipoma, 4 cases of duodenal stromal tumor, 8 cases of duodenal extrinsic protuberance, 6 cases of duodenal cyst and 1 case of duodenal neuroendocrine tumor. One case of duodenal adenoma and 4 cases of duodenal ectopic pancreas. The coincidence rate of mEUS and colonoscopy was 92.85% (26 / 28) and 57.14% (16 / 28) respectively. There were 28 cases of colorectal neoplasms, including 3 cases of colorectal neuroendocrine tumors, 5 cases of colorectal lipomas, 4 cases of colorectal stromal tumors / leiomyomas, 1 case of colorectal endometriosis and 4 cases of colorectal cysts. There were 3 cases of colorectal gas cyst, 6 cases of external compression protuberance and 2 cases of colorectal lymphoma. Conclusion: microprobe endoscopy can clearly display the structure of digestive tract wall and reflect the level of origin and depth of invasion, so it can make an accurate diagnosis for most of the protruding lesions of the digestive tract.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.1;R57

【參考文獻(xiàn)】

相關(guān)期刊論文 前7條

1 郭瑾陶;孫思予;;內(nèi)鏡超聲臨床應(yīng)用的最新進(jìn)展[J];醫(yī)學(xué)與哲學(xué)(B);2016年03期

2 錢鋮;鄒曉平;于成功;呂瑛;張曉琦;李運(yùn)紅;楊天;徐肇敏;;內(nèi)鏡超聲對(duì)胃腸道異位胰腺的診斷價(jià)值[J];中華消化內(nèi)鏡雜志;2011年02期

3 金震東;;超聲內(nèi)鏡在消化系疾病診治中的應(yīng)用進(jìn)展[J];胃腸病學(xué)和肝病學(xué)雜志;2009年01期

4 左文革;李瑜元;;超聲內(nèi)鏡在上消化道疾病診斷與治療中的應(yīng)用[J];臨床超聲醫(yī)學(xué)雜志;2008年02期

5 施勇,錢金岳,陳吳興;異位胰腺的臨床研究進(jìn)展[J];肝膽胰外科雜志;2004年04期

6 彭貴勇,李向紅;超聲內(nèi)鏡對(duì)21例上消化道壁外壓迫性疾病診斷的價(jià)值探討[J];重慶醫(yī)學(xué);2002年02期

7 季峰;陳小麗;金捷;朱麗明;潘杰;許國(guó)強(qiáng);;內(nèi)鏡超聲微探頭檢查對(duì)大腸隆起性病變及癌癥分期的診斷價(jià)值[J];中華消化內(nèi)鏡雜志;2008年06期

，

本文編號(hào)：2206529