108例食管、胃黏膜下隆起超声内镜诊断分析[摘要]目的结合病理分析超声内镜对食管、胃黏膜下隆起的诊治价值。方法选取我院2015年1月～2016年12月常规胃镜检查发现食管、胃黏膜下隆起病变，并行内镜切除或外科切除的108例患者为研究对象，所有患者术前行超声内镜检查，根据不同检查结果选择具体术式，术后行病理检验，以病理检验为金标准，对超声内镜诊断符合率进行分析，并根据病理总结超声内镜误诊经验。结果超声内镜诊断符合率为85.19%，常规胃镜诊断符合率为62.04%，两者比较差异有统计学意义（P2.0cm者，瘤体内点片状高回声稍多，具有恶性倾向者内部回声不均匀更为明显，边缘不规则，侵犯浆膜层。其中7例起源于黏膜肌层，35例起源于固有肌层，10例侵及浆膜层。脂肪瘤5例，表现为均匀一致的高回声，后方常伴有声影，边界清楚，包膜完整，均起源于黏膜下层。囊肿5例，表现为均匀的无回声区，后方回声稍增强，边界清楚，起源于粘膜下层。异位胰腺8例，表现为不均匀的高回声，大部分白光下可见脐样凹陷，内部可见管状结构，边界不清楚，无明显包膜，常累及黏膜下层、固有肌层。结论超声内镜诊断准确性较高，能够分辨食管、胃黏膜下隆起的起源层次，术前可判断隆起病变性质，对临床治疗具有指导作用。[P键词]上消化道；黏膜下隆起；诊断；超声内镜[中图分类号]R575.6[文献标识码]A[文章编号]2095-0616（2017）05-108-04[Abstract]ObjectiveToevaluatethevalueofendoscopicultrasoundinthediagnosisandtreatmentofesophagealandgastricsubmucosallesionscombinedwithpathology.Methods108patientswithesophagealandgastricsubmucosallesionsdetectedbyroutinegastroscopyinourhospitalfromJanury2015toDecember2016，whoweretreatedwithendoscopicresectionorsurgicalresection，wereselectedasourresearchobjects.Allpatientsunderwentendoscopicultrasonography.Accordingtotheresultsofdifferenttests，thespecificoperationwasselecedt.Thepostoperativepathologicalexaminationwasperformedaccordingtothegoldstandardforpathologicalexaminationandthecoincidencerateofconventionalgastroscopyandendoscopeultrasonographywascompared.ResultsThediagnosticaccuracyofendoscopeultrasonographywas85.19%，andthecoincidencerateofconventionalgastroscopywas62.04%.Thedifferencewasstatisticallysignificant（P2.0cmstromaltumorshowedthatintratumoralpatchyhyperechoictumorechowasslightlymore.Theuneveninternalechoofthepatientswithmalignanttendencywasmoreobviouswithirregularedge，andtheserosallayerwasinvaded.Amongthem，7casesoriginatedfromthemuscularismucosae，andother35casesoriginatedfromthemuscularispropria.Inthe10cases，theserosallayerwasinvaded.Therewere5casesoflipoma，whichshoweduniformandhighecho，andtheposteriorpartwasoftenaccompaniedbyacousticshadow.Therewere5cystpatientsandthepatientpresentedwithnoechoarea.Theechobehidethecystwasslightlyenhancedandtheboundarywasclear.Therewere8casesofpatientswithectopicpancreasandtheendoscopeultrasonographyshowedthattherewasaninhomogeneoushighecho.Mostofthepatientswereobservedinthepresenceofthesunkenpitsunderthewhitelight，andnoehcotubularstructureswereobservedunderendoscopicultrasound.Thelesionsgenerallyoriginatedfromthesubmucosaandthemuscularispropria，andtheboundarywasnotclear.ConclusionThediagnosticaccuracyofendoscopicultrasonographyishigh.Itcanbeusedtodistinguishtheoriginofesophagealandgastricsubmucosalprotrusion.Beforeoperation，thenatureofeminencelesionscanbejudged，anditcanbeusedasaguideforclinicaltreatment.[Keywords]Uppergastrointestinaltract；Submucosallesions；Diagnosis；Endoscopeultrasonography食管、胃黏膜下隆起病变是指普通胃镜下观察到食管、胃黏膜表面光滑的隆起，大多由消化道黏膜层以下的肿物或消化...