超声内镜及超声内镜引导下细针穿刺对胃肠道壁增厚及盆腔病变的诊断价值临床医学内科学(消化病学)专业论文.docxVIP

上海交通大学医学院硕士毕业论文 上海交通大学医学院硕士毕业论文 [K [Key words] Thickness of gastric wall; Endosonography; Fine needle aspiration Part I EUS on diagnosis of gastric lesions with thickened gastric wall and negative pathological findings ABSTRACT Objective To evaluate the accuracy and the clinic application of Endosonography (EUS),EUS-guided fine needle aspiration (EUS-FNA) and targeted biopsy in the diagnosis of wall-thickened gastric lesions with negative malignant results of endoscopic biopsies. Methods A retrospective study was carried out in 57 patients who were found with thickened gastric wall of negative malignant endoscopic biopsies and underwent EUS from January 2008 to December 2010 in our hospital. The EUS findings with the surgical results and follow-up status were analyzed.The diagnostic yield of EUS was characterized by the appearance of each layers or the changes of the thickness of gastric wall, the characteristics of echo imaging, and the results of EUS-FNA or EUS targeted biopsy were recorded to evaluate the value of EUS in the diagnosis. Results In all 57 cases, 19 patients were confirmed of gastric cancer, 10 patients were confirmed of lymphoma,1 patients was confirmed of precancerous lesions, 1 patients was confirmed of Menetriers disease and 26 patients were confirmed of inflammatory changes. EUS diagnosed gastric cancer in 26 cases, in which 14(53.8%) were confirmed by pathology. Gastric lymphoma was suspected by EUS in 20 cases, in which 10 (50.0%) were proved. EUS showed the gastric wall thickness around lesions was 5~40mm,average of 14.44±3.64mm.EUS-FNA was conducted in 19 cases, with positive result in 9 (accuracy rate 47.4%). EUS-guided targeted biopsy was performed in 30 cases in all,of which routine biopsy 20,deep biopsy and piece-meal biopsy both 5, with 20 malignant results totally(positive rate 66.7%),of which routine biopsy 12(positive rate 60%),deep biopsy 3(positive rate 60%) and piece-meal biopsy 5(positive rate 100%).All theses leaded t