摘要
目的探讨超声内镜(endoscopic ultrasound,EUS)在胃黏膜下肿瘤(submucosal tumor,SMT)诊断和侵袭危险度分级中的价值。方法采用回顾性研究方法,选取我院收治的,经EUS诊断为胃SMT的190例患者为研究对象,共计197处病灶(其中7例患者胃内均有2处病变)。以病检结果为金标准,计算EUS诊断与病检结果的诊断符合率。收集患者的一般资料和EUS特征,分析影响诊断符合率的因素,并将胃间质瘤(gastric Stromal Tumor,GST)和其他类型的胃SMT病灶分为极低、低、中和高危组,分析预测侵袭危险度分级的因素。最终计算根据EUS诊断制定的术前方案与最终实际手术方案符合率。结果EUS对胃SMT的病检诊断符合率为69.04%(136/197)。符合诊断的患者年龄>60岁占比明显高于不符合诊断的患者(P<0.05);符合诊断的病灶EUS显示回声不均占比明显高于不符合诊断的病灶(P<0.05)。患者年龄>60岁、EUS显示病灶回声不均是诊断符合率的独立影响因素(P<0.05)。侵袭危险度越高,EUS显示病灶回声不均匀、有加彩和边界不清越常见(P<0.05)。EUS显示病灶回声不均匀、有加彩是预测侵袭危险度分级的独立因素(P<0.05)。有1处病灶术中未能分离,余顺利,手术方案符合率为99.49%(196/197)。结论EUS诊断胃SMT与术后病检结果具有较好的一致性。患者年龄>60岁、EUS显示病灶回声不均,EUS诊断符合率更高。不同侵袭危险度的胃SMT在EUS图像中的表现有差异,EUS显示病灶回声不均、有加彩是预测侵袭危险度的重要标志。EUS对手术方案的选择有重要指导价值。
Objective To explore the value of endoscopic ultrasonography(EUS)in the diagnosis and invasion risk classification of submucosal tumor(SMT).Methods 190 patients with gastric SMT diagnosed by EUS in Second Affiliated Hospital of Chongqing Medical University were enrolled by retrospective study,with a total of 197 lesions(including 7 patients with 2 lesions in the stomach).Taking pathological results as the gold standard,the diagnostic accuracy rate between EUS diagnosis and pathological results was calculated.The demographic data and EUS characteristics of patients were collected,and the factors influencing the diagnostic accuracy rate were analyzed.Gastric Stromal Tumor(GST)and other types of gastric SMT lesions were divided into extremely low,low,medium and high-risk groups,and the factors predicting the invasion risk classification were analyzed.Finally,the accuracy rate between the preoperative plan based on EUS diagnosis and the final actual surgical plan is calculated.Results The pathological diagnosis accuracy rate of EUS for gastric SMT was 69.04%(136/197).The diagnostic accuracy was higher in older patients over 60(P<0.05).The proportion of ultrasonic inhomogeneity inside the lesions that meet the diagnosis is significantly higher than that inside the lesions that do not meet the diagnosis(P<0.05).The patient′s age>60 years old and the ultrasonic inhomogeneity were independent influencing factors of the diagnostic accuracy rate(P<0.05).The higher the risk of invasion,the more common ultrasonic inhomogeneity,blood flow signal inside the lesions and unclear boundary(P<0.05).Ultrasonic inhomogeneity and blood flow signal inside the lesions were independent factors to predict the invasion risk(P<0.05).All lessions were successfully endoscopic resected except one GST.The accuracy rate of operation scheme was 99.49%(196/197).Conclusion EUS diagnosis of gastric SMT is in good agreement with postoperative pathological results.The patient′s age is over 60 years old,ultrasonic inhomogeneity inside the lesions,a
作者
戴丽
宁波
DAI Li;NING Bo(Department of Gastroenterology,Second Affiliated Hospital of Chongqing Medical University,Chongqing 400000,China)
出处
《现代消化及介入诊疗》
2023年第2期160-167,共8页
Modern Interventional Diagnosis and Treatment in Gastroenterology
基金
国家自然科学基金(面上项目)(CSTB2022NSCQ-MSX0130)。
关键词
超声内镜
胃黏膜下肿瘤
诊断符合率
影响因素
侵袭危险度
Endoscopic ultrasound
Gastric submucosal tumor
Diagnostic compliance rate
Influence factor
Risk of invasion
