20例食管结核的超声内镜特点分析

摘要

目的:探讨食管结核的超声内镜表现特点, 进而提高食管结核的诊断率.方法:回顾性分析收治的20例诊断食管结核患者的超声内镜表现和临床特征.结果:内镜表现, 病变位于食管上段2例, 中段17例, 下段1例;病灶为隆起表面黏膜光滑5例, 隆起并溃疡或糜烂9例, 单纯溃疡型6例, 其中并食管狭窄11例, 并窦道形成3例.超声表现, 14例隆起病灶 (包括表面并糜烂或溃疡者) 表现食管壁内见有点状或条索状高回声、钙化灶中低回声团块, 病变边界不清, 其中5例病变突向纵隔内;6例溃疡型病灶表现为病变处食管管壁明显增厚, 呈不均匀低回声改变, 溃疡处表面有不同层次缺损.20例病例中纵隔内均见一枚或多枚呈圆形或椭圆形, 回声偏高, 边界不清, 部分相互融合, 或内可见强光点或钙化影肿的肿大淋巴结.内镜活检确诊5例 (30％) 、超声穿刺确诊4例 (80％) 、临床疑诊11例 (55％) .所有患者均经抗结核治疗6个月后病情缓解, 随访半年至2年均无复发.结论:食管结核发病率低, 诊断困难, 超声内镜检查对食管结核的诊断有重要临床价值.%Objective To investigate the endoscopic ultrasound features of esophagea tuberculosis, in order to improve the diagnosis rate of esophageal tuberculosis. Method Retrospective analyse the clinical features and endoscopic ultrasound manifestations of 20 cases of esophageal tuberculosis. Results Endoscopic manifestations:2 cases with lesions located in the upper segment of esophagus, 17 cases in the middle and 1 case in the lower segment. And 5 cases were protuberant lesions with smooth surface, 9 cases were protuberant lesions with erosion or ulcer, 6 cases were with simple ulcer, 11 cases with esophageal stenosis, and 3 cases with sinus formation. Ultrasonography manifestations:With 14 cases of protrusion lesions (including lesions with erosion or ulcer), we could observe punctate or cords high echo, and low echo mass in calcification in the esophagus wall, and the boundary of lesions is not clear. With 5 cases of protrusion lesions, we could observe esophageal wall thickening significantly, with uneven hypoechoic changes, and with different levels of defects at ulcer surface. With 20 cases, we could observe one or more enlarged lymph nodes, round or oval, with high echo, and unclear boundary, and partial fusion, or with light point or Calcification. Diagnosis:5 cases were diagnosed with endoscopic biopsy (accounted for 30％ in all), 4 cases were with ultrasonic puncture (accounted for 80％ in all), and 11 cases were clinical suspected (accounted for 55％ in all). The symptoms of all cases were remissed by treatment with anti-tuberculosis drugs, and there is no recurrence in follow-up 6 months to 2 years. Conclusion The morbidity of esophageal tuberculosis is low, and the diagnosis is difficult. The endoscopic ultrasonography has important clinical value in diagnosis of esophageal tuberculosis.