摘要
背景超声内镜兼具内镜检查和超声扫描功能,由于肠道解剖结构较为复杂,在结直肠病变中对超声内镜的研究较少,通过探讨超声内镜检查在结直肠病变中的作用,可为临床工作提供一定的诊断价值.目的探讨超声内镜检查在结直肠及周围病变诊断中的临床应用价值.方法回顾性分析2018-09/2021-07,95例结直肠及周围病变患者的小探头和大探头超声内镜检查结果,并与术后病理对照.统计学方法采用kappa检验.结果与术后病理相比:(1)大探头超声内镜检查判断直肠癌浸润深度T分期的准确率为73.9%(17/23):T1期2/4,T2期4/6,T3期6/7,T4期5/5;判断评估区域淋巴结转移N分期的准确率为91.3%(21/23):N014/15,N17/8;一致性较好(kappa值为0.782,P<0.01);(2)小探头超声内镜在结直肠腺瘤或早癌内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)术前评估中判断肿瘤浸润深度的准确率为87.1%(27/31),一致性一般(kappa值为0.665,P<0.01);(3)小探头超声内镜判断结直肠黏膜下隆起性病变起源和类型的准确率为95.5%(21/22),一致性高(kappa值为0.919,P<0.01).(4)超声内镜引导细针穿刺诊断直肠及其周围病变的准确率为70.0%(7/10),一致性一般(kappa值为0.565,P<0.01).结论根据结直肠及其周围病变具体部位、大小,选择性应用小探头或大探头超声内镜检查,对直肠癌TN分期、ESD术前评估、判断结直肠黏膜下隆起性病变特点及获取直肠及其周围病变组织标本具有重要价值.
BACKGROUND Endoscopic ultrasonography(EUS)has the functions of both endoscopy and ultrasound.Due to the complex anatomical structure of the intestine,there are few studies on EUS in colorectal lesions.AIM To explore the clinical application value of EUS in the diagnosis of colorectal and peri-colorectal lesions.METHODS We retrospectively analyzed the examination results of 95 patients detected by endoscopic miniprobe sonography(MPS)and linear EUS from September 2018 to July 2021,which were then compared to postoperative pathology.The kappa test was used in statistical analysis.RESULTS Using postoperative pathology as the golden standard,the accuracy of linear EUS in diagnosing the depth of rectal cancer invasion(T stage)was 73.9%(17/23 cases),including T1(2/4 cases),T2(4/6 cases),T3(6/7 cases),and T4(5/5 cases)stages.The accuracy of linear EUS in diagnosing regional lymph node metastasis(N stage)was 91.3%(21/23 cases),including N0(14/15 cases)and N1(7/8 cases)stages.The consistency was high(kappa value=0.782,P<0.01).During preoperative evaluation of colorectal adenoma or early cancer before endoscopic submucosal dissection(ESD),the accuracy of MPS in diagnosing the depth of tumor invasion was 87.1%(27/31 cases),and the consistency was moderate(kappa value=0.665,P<0.01).The accuracy of MPS in diagnosing the origin and type of colorectal submucosal lesions was 95.5%(21/22 cases),and the consistency was high(kappa value=0.919,P<0.01).The accuracy of endoscopic ultrasonography-guided fine-needle aspiration in determining rectal and peri-rectal lesions was 70.0%(7/10 cases),and the consistency was moderate(kappa value=0.565,P<0.01).CONCLUSION According to the specific location and size of colorectal and peri-colorectal lesions,selective use of the MPS and linear EUS is of great value with regard to T/N staging of rectal cancer,preoperative evaluation of ESD,determination of the characteristics of colorectal-submucosal bulging lesions,and acquisition of lesion tissue of rectal and peri-rectal lesions.
作者
唐曦平
陈金凤
刘爱群
沈妍华
黄月丽
Xi-Ping Tang;Jin-Feng Chen;Ai-Qun Liu;Yan-Hua Shen;Yue-Li Huang(Guangxi Medical University Cancer Hospital,Nanning 530021,Guangxi Zhuang Autonomous Region,China)
出处
《世界华人消化杂志》
CAS
2022年第14期647-654,共8页
World Chinese Journal of Digestology
基金
广西卫生适宜推广项目,No.S2020103
广西自然科学基金面上项目,No.2020GXNSFAA297062
广西中医药管理局科研项目,No.GZZC2020235.
关键词
超声内镜
结直肠病变
临床分析
Endoscopic ultrasonography
Colorectal lesions
Clinical analysis
