摘要
目的探讨超声内镜联合活检组织病理对恶性胃溃疡假性愈合的诊断与鉴别诊断价值。方法收集2013年1月至2019年7月我院胃镜诊断为胃溃疡5 266例患者资料,回顾性分析胃溃疡患者的胃镜诊断、超声内镜诊断、病理活组织检查诊断结果。结果 348例进行活检的愈合期胃溃疡中最终确诊为良性溃疡331例(95.1%),恶性溃疡17例(4.9%),恶性胃溃疡假性愈合率为4.9%。假性愈合前,恶性胃溃疡大小明显大于良性胃溃疡(P=0.000),但非甾体类胃溃疡除外。胃镜下假性愈合者病灶黏膜表面粗糙,黏膜纠集,甚至可见异常血管,且略显僵硬;良性胃溃疡表面光滑,蠕动正常。EUS下病灶范围显著大于内镜白光下范围(P=0.000)。超声内镜下良恶性胃溃疡破坏层次也不同,差异有统计学意义(P=0.036)。结论超声内镜联合活检组织病理有助于恶性胃溃疡假性愈合的诊断和鉴别诊断,从而能避免不必要的漏诊和误诊。
Objective To explore the differentially diagnostic significance of endoscopic ultrasonography combined with biopsy for pseudo-healing of malignant gastric ulcers. Methods A total of 5 266 patients diagnosed with gastric ulcers under gastroscopy from Jan. 2013 to Jul. 2019 in Renmin Hospital of Wuhan University were retrospectively analyzed, then the results of gastroscopy, endoscopic ultrasonography and pathological biopsy in patients with gastric ulcer were analyzed. Results In the healing gastric ulcers, 348 cases were biopsied. 331 cases(95.1%) were finally diagnosed as benign ulcers and 17 cases(4.9%) were confirmed as malignant ulcers by biopsy. The pseudo healing rate of malignant gastric ulcers was 4.9% among all gastric ulcer patients. Before healed, the size of malignant gastric ulcers was significantly larger than that of benign gastric ulcers(P=0.000), except for non-steroidal gastric ulcers. After pseudo healed, if the mucosa around the ulcer was coarse, congested, even abnormal vessels visible and slightly stiff, that may indicate pseudo-healing of malignant gastric ulcers. While a smooth surface and normal peristalsis indicated benign gastric ulcers. EUS performance: for pseudo-healing of malignant gastric ulcers, the lesion scope was significantly larger than that under the endoscopy(P=0.000). And the damage layers of benign ulcer and malignant gastric ulcers were also different in EUS, and the difference was statistically significant(P=0.036). Conclusion Endoscopic ultrasonography combined with biopsy is helpful for the diagnosis and differential diagnosis of pseudo-healing of malignant gastric ulcers, so as to avoid unnecessary missed diagnosis and misdiagnosis.
作者
马凤梅
李明
谭诗云
MA Fengmei;LI Ming;TAN Shiyun(Department of Gastroenterology,Renmin Hospital of Wuhan University,Wuhan 430060,China)
出处
《胃肠病学和肝病学杂志》
CAS
2020年第5期534-539,共6页
Chinese Journal of Gastroenterology and Hepatology
基金
中央高校基本科研业务费专项资金项目(2042017kf0092)。
关键词
恶性胃溃疡
假性愈合
超声内镜
活检
Malignant gastric ulcer
Pseudo-healing
Endoscopic ultrasonography
Biopsy
