超声定位下凿洞式深挖活检对Borrmann Ⅳ型胃癌诊断价值探讨.docVIP

超声定位下凿洞式深挖活检对Borrmann Ⅳ型胃癌诊断价值探讨 　　【摘要】 目的：探讨超声内镜定位下凿洞式深挖活检对Borrmann Ⅳ型胃癌诊断的价值。方法：回顾性分析病理确诊的53例Borrmann Ⅳ型胃癌的临床资料，比较常规活检及超声内镜定位下凿洞式深挖活检对Borrmann Ⅳ型胃癌的诊断结果。结果：常规胃镜首次活检诊断Borrmann Ⅳ型胃癌阳性率30.2%（16/53），活检阴性患者多次重复活检阳性率13.5%（5/37），常规内镜活检总阳性率为39.6%（21/53）。46例Borrmann Ⅳ型胃癌患者行超声内镜检查，诊断与病理符合率为95.5%（44/46）。21例多次活检阴性患者行超声内镜定位下凿洞式深挖活检，术后标本送病理检查阳性率61.9%（13/21）。仅2例患者活检后创面少量渗血，所有患者术后观察无出血、穿孔等并发症发生。结论：超声内镜定位下凿洞式深挖活检显著提高Borrmann Ⅳ型胃癌临床内镜活检阳性率，为Borrmann Ⅳ型胃癌的诊断提供了更有效的病理确诊依据。该操作安全性高，费用少，值得临床推广。 　　【关键词】 Borrmann Ⅳ型胃癌； 胃镜活检； 超声内镜； 深挖活检 　　中图分类号 R730.4 文献标识码 B 文章编号 1674-6805（2014）26-0063-02 　　【Abstract】 Objective： To evaluate the diagnostic yield of EUS-guided holing biopsy in Borrmann type Ⅳ gastric cancer.Method：The clinical diagnose data of 53 cases of Borrmann type Ⅳ gastric cancer patients who were confirmed pathologically by operation examination or gastroscopy were analyzed retrospectively.Result：The positive rate of first routine biopsy was 30.2%（16/53）. The cases with negative first routine biopsies were treated with repeated biopsies（2-4 times），and the positive rate was 13.5%（5/37）.The overall positive rate of gastroscopic routine biopsy was 39.6%（21/53）.46 cases were diagnosised by EUS，and the coincidence rate in diagnosing Borrmann type IV gastric cancer was 95.5%（44/46）.The cases with negative gastroscopic routine biopsy were treated with EUS-guided holing biopsys， and the positive rate was 61.9%（13/21）. Minor bloods oozing in 2 patients were controlled by epinephrine. Neither severe hemorrhage nor perforation was founded in any cases. Conclusion：EUS-guided holing biopsy has superiority of raising the positive rate of gastroscopic biopsy. It is an effective technique to diagnosis Borrmann type Ⅳ gastric cancer with pathological basis. And the technique is safety and inexpensiveness. 　　【Key words】 Borrmann type Ⅳ gastric cancer； Gastroscopic biopsy； EUS； Holing biopsy 　　First-author’s address： The First Affiliated Hospital of Zhejiang University，Hangzhou 310003，China 　　B