Diagnostic value of endoscopic ultrasonography for submucosal tumors of digestive tract
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摘要:
目的 探讨超声内镜(EUS)对消化道黏膜下肿瘤(SMT)的诊断价值。 方法 选取合肥市第一人民医院2015年7月—2020年8月收治的SMT患者82例，患者均行EUS检查；根据EUS结果选择不同的手术方式，包括内镜黏膜下剥离术(ESD)、内镜黏膜下挖除术(ESE)、经黏膜下隧道内镜肿瘤切除术(STER)、内镜全层切除术(EFTR)等，比较EUS与病理结果的诊断符合率、根据EUS诊断结果制定的术前方案与实际的手术方案符合率。 结果 EUS能清晰显示消化道SMT的层次来源、大小、回声、边界；经EUS诊断85例病灶，12例EUS诊断与病理诊断不一致，其中2例食管间质瘤、2例胃间质瘤、1例胃窦血管球瘤、1例副脾、1例神经鞘瘤、1例腺肌瘤、1例纤维瘤误认为平滑肌瘤，2例胃平滑肌瘤、1例胃体异位胰腺均误认为间质瘤，EUS诊断与病理诊断结果符合率为85.9%(73/85)；ESD手术40例，ESE手术34例，STER手术2例，EFTR手术9例，其中2例术中转腹腔镜术，术后无出血、穿孔等并发症，根据EUS制定的术前方案与实际的手术方案符合率为97.6%(83/85)。 结论 EUS是诊断消化道SMT较准确的方法，对内镜下治疗方式的选择有重要指导价值。 Abstract:Objective To explore the value of endoscopic ultrasound (EUS) in the diagnosis of submucosal tumors (SMT) of digestive tract. Methods Total 82 patients with SMT accepted EUS examination and treated at the First People's Hospital of Hefei from July 2015 to August 2020 were recruited. According to EUS results, different surgical methods were choose, including endoscopic submucosal dissection (ESD), endoscopic submucosal excision (ESE), submucosal tunnel endoscopic tumor resection (STER), and endoscopic full-thickness resection (EFTR) etc. The diagnostic coincidence rate between EUS and pathological results, and the coincidence rate between the preoperative plan based on EUS diagnosis and the actual surgical plan were compared. Results EUS could clearly display the layer of origin, size, echo, and the relationship with surrounding tissues of the SMT. Among 85 lesions diagnosed by EUS, 12 cases were different from pathological and EUS, including 2 cases of esophageal stromal tumor, 2 cases of gastric stromal tumor, 1 case of gastric antral hemangioma, 1 case of accessory spleen, 1 case of schwannoma, 1 case of adenomyoma and 1 case of fibroma misdiagnosed as leiomyoma, 2 cases gastric leiomyoma and 1 case of gastric ectopic pancreas misdiagnosed as stromal tumors. The coincidence rate of EUS and pathological diagnosis was 85.9% (73/85). There were 40 cases of ESD operation, 34 cases of ESE operation, 2 cases of STER operation and 9 cases of EFTR operation, of which 2 cases were converted to laparoscopy. There were no complications such as bleeding and perforation after operation. The coincidence rate between the preoperative plan formulated according to EUS and the actual surgical plan was 97.6% (83/85). Conclusion EUS is a highly accurate method to diagnose SMT of digestive tract in the gastrointestinal tract, and has important guiding value for the choice of endoscopic treatment. -
图 1 贲门固有肌层SMT、ESE
注：A为贲门见一黏膜下肿瘤；B为超声所示，病灶来源于固有肌层，大小1.7 cm×0.9 cm，呈低回声，边界清楚；C为予病灶周围标记；D为黏膜下分离病灶；E为ESE术后创面；F为ESE术后标本。
图 2 胃底固有肌层SMT、EFTR
注：A为胃底大弯侧见一黏膜下肿瘤；B为超声所示，病灶来源于固有肌层，大小1.2 cm×0.86 cm，呈低回声，与浆膜层相连；C为予以黏膜下分离病灶；D为EFTR术后创面；E为止血夹“吸引-夹闭-缝合”创面；F为EFTR术后标本。
表 1 消化道黏膜下肿瘤的超声内镜特征
黏膜下肿瘤 病变起源 回声 形态 边界 平滑肌瘤 黏膜肌层32例，固有肌层12例 均匀低回声39例, 不均质低回声5例 圆形、椭圆形、梭形 清晰，2例向腔外生长，边界不清 间质瘤 黏膜肌层1例，黏膜下层1例，固有肌层24例 均匀低回声4例，周边低回声、中间高回声3例，回声不均19例 圆形、椭圆形 清晰，3例向腔外生长，边界不清 异位胰腺 固有肌层4例 混合回声4例，其中1例中间有分隔 梭形、椭圆形 清晰 脂肪瘤 黏膜下层2例 均匀高回声2例 椭圆形 清晰 神经内分泌肿瘤 黏膜下层4例 低回声4例 圆形、椭圆形 清晰 异位副脾 固有肌层1例 均匀低回声1例 椭圆形 清晰 血管球瘤 固有肌层1例 均匀低回声1例 椭圆形 清晰 神经鞘瘤 固有肌层1例 均匀低回声1例 椭圆形 清晰 腺肌瘤 固有肌层1例 均匀低回声1例 圆形 清晰 纤维瘤 固有肌层1例 均匀低回声1例 椭圆形 清晰 
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