超声内镜在消化疾病中的临床应用

1、会计学1超声内镜在消化疾病中的临床应用超声内镜在消化疾病中的临床应用EUS诊断EUS穿刺活检（EUS-FNA）EUS注射治疗（EUS-FNI）诊断评价 Diagnostic evaluation陈XX，男，61中上腹饥饿痛王XX，男，64y中上腹痛肿大淋巴结腹水黄XX，男，64结构破坏，增厚；不规则低回声；项XX，男，60胃壁弥漫性全层增厚第4层低回声带中混有散在的强回声斑点EUS stagingEUS stagingNo. Author Year of No. ofType of Confirmatory publication patients study procedure 1 Grim

2、m et al 1993 147 Prospective Surgery 2 Francois et al 1996 29 Consecutive Surgery 3 Schimizu et al 1994 125 Consecutive Surgery 4 Dittler et al 1993 254 Consecutive Surgery 5 Ziegler et al 1993 118 Prospective Surgery 6 Botet et al 1991 50 Prospective Surgery 7 Xi et al 2003 35 Prospective Surgery 8

3、 Caletti et al 1991 42 Prospective Surgery 9 Akahoshi et al 1989 74 Prospective Surgery 10 Tio et al 1989 72 Prospective Surgery 11 Massari et al 1996 99 Prospective Surgery 12 Saito et al 1991 110 Prospective Surgery 13 Murata et al 1988 146 Prospective Surgery 14 Hunerbein et al 1996 19 Consecutiv

4、e Surgery 15 Perng et al 1996 69 Consecutive Surgery 16 Tio et al 1989 75 Prospective Surgery 17 Tio et al 1986 36 Prospective Surgery 18 Shimoyama et al 2004 45 Consecutive Surgery 19 Willis et al 2000 116 Consecutive Surgery 20 Rosch et al 1992 41 Consecutive Surgery 21 Javaid et al 2003 112 Conse

5、cutive Surgery 22 Potrc et al 2006 82 Prospective Surgery sensitivity specificity Pooled DOR T1 88.1% (84.5-91.1) 100.0% (99.7-100.0) 605.6 (296.8-1235.6) T2 82.3% (78.2-86.0) 95.6% (94.4-96.6) 108.6 (56.6-208.1) T3 89.7% (87.1-92.0) 94.7% (93.3-95.9) 144.4 (95.4-218.7) T4 99.2% (97.1-99.9) 96.7% (9

6、5.7-97.6) 507.8 (247.5-1042.1) N1 58.2% (53.5-62.8) 87.2% (84.4-89.7) 9.5 (5.3-16.9) N2 64.9% (60.8-68.8) 92.4% (89.9-94.4) 26.6 (13.9-50.7) Nattermann Ziegler Botet n=50(%) n=108(%) n=50(%)T分期分期 EUS828692 CT254342N分期分期 EUS787478 CT485148EUS与CT检查的比较EPM van Vliet et al,British Journal of Cancer 2007;

7、 97: 868 876对569例食管和贲门癌患者研究单独单独CT CT 检测远处转移的敏感度：腹腔淋巴结（检测远处转移的敏感度：腹腔淋巴结（69%69%），肝），肝（73%73%），肺（），肺（90%90%），锁骨上），锁骨上LNLN（28%28%）B B超：腹腔淋巴结（超：腹腔淋巴结（44%44%），肝（），肝（65%65%），锁骨上），锁骨上LNLN（85%85%）EUSEUS：腹腔淋巴结（：腹腔淋巴结（38%38%）胸片：肺（胸片：肺（68%68%）CTCT与与B B超联合：总体敏感度超联合：总体敏感度86%86%，特异性，特异性95%95%Lee et al. Gut 2005;54

8、:15411545.章XX，男，75腹胀良性？ 恶性？祝XX，女，55腹胀周XX，男，65触及腹块Martnez-Ares et al. Rev Esp Enferm Dig 2005; 97: 416-426.CharacteristicRelative riskIC to 95%significantUlceration3.751.02-13.79significantSize above 4cm3.591.02-14.9significantIrregular edges27.53.01-250.7significantHeterogeneous echogenicity9.532.23

9、-39.13significantCystic areas6.661.50-30.64significantHyperechogenic areas4.020.68-23.9NS邹XX女，47y芦XX，女，82y李XX，男，71郎XX，女，56孙XX，女，45大便次数增多严重低蛋白血症细针穿刺ERCP检查示远端胆总管狭窄胆总管远端占位，近端扩张胰头肿瘤USEUSCTMRIMuller et al3cm93%53%67%2cm90%40%33%Ardengh et al3cm100%94%Agarwal et al94%86%DeWitt et al98%86%Angelis CD et al7

10、5%98%80%AuthoryearNO. of patientssensitivityspecificityOverall accuracyEloubeidi et al200315884.3%97%84%Eloubeidi et al200754795%92%94.1%Ardengh JC et al2007611(general)78.4%99.2%87.2%225(Solid Tu3cm)78.8%100%83.1%180(Solid Tu3cm)82.4%98.4%87.8%206(cystic lesions)72.2%99.3%92.2%AuthorNo. of patients

11、Microlithiasis/AIPGarg et al7510/75Tandon et al315/13Liu et al8914/18EUS对诊断慢性胰腺炎更为敏感EUSUSERCPCTSensitivity88%58%74%75%Specificity100%75%100%95%EUS staging章XX，男，75腹胀Martnez-Ares et al. Rev Esp Enferm Dig 2005; 97: 416-426.CharacteristicRelative riskIC to 95%significantUlceration3.751.02-13.79significantSize above 4cm3.591.02-14.