摘要：目的 探讨内镜超声(EUS)对上消化道病变的诊断价值及流行病学评价.方法 连续收集2004～2008年3032例次上消化道内镜超声检查病例,分析超声图像特征及检查结果,并采用流行病学方法进行前瞻性评价内镜超声检查对癌分期、病变层次来源、病变囊性与实质性、溃疡良恶性的诊断价值.结果 隆起型病灶1419枚(实际壁内病灶1019枚)、进展期癌664例、早期癌11例、溃疡病96例、息肉142枚、其他700例;1019枚上消化道隆起病灶中,低回声表现最多(588/1019,57.7%),主要是平滑肌瘤414/414枚、间质瘤128/133枚、淋巴瘤7/7枚、类癌2/2枚和黏膜下癌26/28枚;无回声病灶(囊肿80/82枚、血管瘤60/66枚、Brunner腺增生33/36枚)和高回声(脂肪瘤52/54枚)多为良性病变;其中得到病理证实或前后两次检查者716例,内镜超声对病灶来源层次的诊断敏感度96.6%,特异度95.1%,符合率95.9%.对病灶囊性与 实质性判别的敏感度98.7%,特异度90.9%,符合率97.9%.内镜下不易鉴别良恶性的溃疡32例,根据回声及浸润情况判断良恶性敏感度82.3%,特异度80.0%,符合率81.3%.上消化道恶性肿瘤376例(食管癌266例、贲门癌28例、胃癌82例),内镜超声对判断肿瘤浸润深度的敏感度85.5%,特异度86.4%,符合率85.9%;对局部淋巴结转移诊断的敏感性度78.3%,特异度80.2%,符合率79.3%.结论 内镜超声检查对上消化道病变有很高的定位诊断价值和较好的定性诊断价值,对制定治疗方案有很好的指导作用.但要注意它仍具有影像学诊断方法的局限性,尤其是定性诊断.%Objective To explore the endoscopic ultrasound( EUS)and epidemiological evaluation of the upper gastrointestinal tract lesions.Methods 3032 cases of upper gastrointestinal endoscopic ultrasonography were collected and analyzed, and epidemiological method was used to forward-lookingly assess EUS in cancer staging, pathological source,cystic substantive lesion and the diagnosis of benign and malignant ulcers.Results 1419 cases had protuberant lesions( 1019.of them in gastrointestinal tract wall ), 664 cases with advanced cancer, 11 cases with early cancer,96 cases with ulcer disease, 142 cases with polyps and the other 700 cases.Among 1019 protuberant lesions in tract wall,hypoechoic type is the most common (588/1019,57.7％), which included leiomyoma 414/414, stromal tumor 128/133, lymphoma 7/7, carcinoid 2/2 and submucosal surface cancer 26/28, and anechoic type including cystic lesion( 80/82 cysts, hemangioma 60/66, Brunner gland hyperplasia 33/36 ) and hyperechoic type ( lipoma 52/54 )are generally benign lesions.Among them, there were 716 cases confirmed by pathology or by two different examiners.The sensitivity of endoscopic ultrasonography was 96.6％ ,the specificity was 95.1％ and the agreement rate was 95.9％ in the diagnosis of the lesion source level ,and the discrimination sensitivity between cystic and substantive lesions was 98.7％ ,the specificity was 90.9％ and the agreement rate was 97.9％.There were 32 cases of ulcer disease difficult to identify whether benign or malignant by endoscopic method, and according to echo and the infiltration,the sensitivity of benign or malignant determination was 82.3％ ,the specificity was 80.0％ and theagreement rate was 81.3％.There were 376 cases of upper digestive tract cancer,including 266 esophageal cancer,28 cardiac cancer and 82 gastric cancer cases.The sensitivity of endoscopic ultrasonography in judging tumor invasion depth was85.5％ ,the specificity was 86.4％ ,the agreement rate was 85.9％ ,and the sensitivity in diagnosing local lymph node metastasis was 78.3％ ,the specificity was 80.2％ and the agreement rate was 79.3％.Conclusions EUS has a high diagnostic value for the upper gastrointestinal tract lesions, but it has limitations as an imaging diagnostic method, especially for qualitative diagnosis.
