原发性胃淋巴瘤临床与内镜特征分析

目的:探讨影像学检查及胃镜、超声内镜对原发性胃淋巴瘤的术前诊断方法,以提高该疾病的术前诊断率。方法:总结我院经手术及病理证实的21例原发性胃淋巴瘤资料,评估胃镜活检、超声内镜及CT对该病诊断的作用。结果:21例术前CT检查,误诊为浸润型胃癌11例,间质瘤2例,未见明显异常3例。CT术前诊断率为23.8%(5/21)。全部患者均实施胃镜检查,活检病理诊断淋巴瘤14例,胃镜活检诊断率为66.7%(14/21)。其中10名患者实施超声胃镜检查,判断胃淋巴瘤6例、胃癌3例、间质瘤1例;术前诊断率为60.0%(6/10)。结论:胃镜及超声内镜是原发性胃淋巴瘤的主要术前诊断方式;CT扫描能明确有无纵隔及腹腔内淋巴结肿大,为原发性胃淋巴瘤提供诊断依据。     

胃间质瘤11例临床诊治分析

目的:探讨胃间质瘤(GST)的诊断和治疗措施.方法:回顾性分析我院2000年4月至2006年3月近6年收治的1I例胃间质瘤患者的临床表现、辅助检查、手术治疗方式及病理结果.结果:临床以消化道出血、腹部肿块表现为主,症状无特异性,所有病例术前均行胃镜及CT检查,均行手术治疗,其中6例行肿瘤楔形切除,5例行胃大部切除术,病理诊断良性5例(45.5%)交界性1例(9%),恶性5例(45.5%).随访时间3个月至5年,死亡1例,死于腹腔广泛转移.结论:胃间质瘤缺乏特异的临床表现,术前诊断困难,胃镜和CT可发现病变,诊断以病理诊断为准,其中免疫组化结果为重要诊断依据,治疗以手术切除为主.     

超声检查对梗阻性黄疸的诊断价值

目的探讨超声检查技术在诊断梗阻性黄疸中的应用价值。方法选择2015年6月~2016年6月在我院行超声检查确诊梗阻性黄疸患者60例为研究对象,将术前超声检查结果与术后病理结果进行对比,分析超声检查在梗阻性黄疸中的诊断符合率。结果术后病理证实,肝外阻塞性黄疸27例(45.00%),肝内阻塞性黄疸33例(55.00%)。术前超声诊断为肝外阻塞性黄疸26例(43.33%),肝内阻塞性黄疸32例(53.33%),漏诊2例(3.34%);与术后病理结果比较,超声检查梗阻性黄疸的诊断符合率为96.67%,超声诊断与病理结果比较,差异无统计学意义(P0.05)。结论超声在梗阻性黄疸的诊断中具有较好的诊断效果,诊断符合率较高,安全性好,值得临床推广应用。     

超声内镜对消化道隆起性病变的诊断价值

目的:探讨超声内镜(EUS)对消化道隆起性病变的诊断价值。方法:回顾性分析2013年2月到2017年6月于我院行EUS检查并经内镜下黏膜剥离术(ESD)、内镜粘膜切除术(EMR)或超声内镜引导下细针穿刺(EUS-FNA)获取诊断的293例有消化道隆起性病变的患者,分析病变的超声特点,对比病变的诊断结果。结果:在293例患者中,270例超声诊断与最终诊断相符,EUS诊断消化道隆起性病变的准确性为92.3%。在多种隆起性病变中,以平滑肌瘤(30.7%)及间质瘤(32.4%)最多见,超声对平滑肌瘤及间质瘤的诊断准确性分别为87.8%、95.8%。结论:EUS对消化道隆起性病变是一种有效的、准确的初步诊断方法。     

超声胃镜小探头对上消化道黏膜下病变的诊断价值探讨

目的:探讨超声胃镜小探头对上消化道黏膜下病变的诊断价值.方法:使用超声胃镜小探头对我院2010年6月-2011年12月62例经电子胃镜检查的上消化道黏膜下病变患者进行检查,对病变的浸润范围与性质进行分析,结果与术后病理进行对比.结果:良性间质瘤43例,占69.35％,恶性间质瘤6例,占9.68％,异位胰腺5例,占8.06％,囊肿6例,占9.68％,脂肪瘤与静脉曲张各1例,占1.61％.所有结果均经病理检查证实,符合率100％,结果具有代表性(P＜0.05).结论:使用超声胃镜小探头能清楚显示上消化道各层管壁结构,确定上消化道黏膜下病变的性质,提高诊断率,具有极高的临床价值,可作为上消化道黏膜下病变的诊断方法在临床推广应用.     

胃增强CT与超声双重造影诊断胃间质瘤临床价值研究

目的:探讨胃增强CT与超声双重造影诊断胃间质瘤的临床价值。方法:收取2010年1月至2016年1月间于我院就诊的胃间质瘤患者43例作为研究对象,对其胃增强CT与超声双重造影检查结果进行回顾性分析,总结两种方法的诊断准确率。结果:将43例胃间质瘤患者分为高危型17例及低危型26例,分别纳入高危组及低危组。高危组肿瘤大小5 cm患者例数明显多于低危组,有液化坏死现象的患者也明显较多,差异有统计学意义(P0.05)。增强CT胃间质瘤总检出率为95.35%,超声双重造影胃间质瘤总检出率为86.05%,联合检测胃间质瘤检出率高达97.67%,高于两种方法单独检测,但差异不具有统计学意义(P0.05)。增强CT定位准确率为65.85%,超声双重造影定位准确率为97.30%,联合检测定位准确率高达100%,较单独检测差异显著(P0.05)。结论:增强CT与超声双重造影在不同类型胃间质瘤的定位及定性诊断中各具优势,二者联合使用可显著提高胃间质瘤诊断准确率,值得临床推广。     

电视宫腔镜配合阴道超声检查诊治80例绝经后子宫出血的效果分析

目的:评价宫腔镜配合阴道超声检查对绝经后妇女异常子宫出血的临床价值.方法:回顾性分析80例绝经后妇女异常子宫出血行宫腔镜配合阴道超声检查及相关病理检查的临床资料.结果:阴道超声检查非正常41例,阳性率为51.25%,官腔镜检查非正常58例,阳性率为72.50%,两者比较具有统计学意义(P＜0.01);病理检查非正常54例,符合率为93.10%.结论:阴道超声检查可作为异常子宫出血的常规无创普查手段,宫腔镜检查可对异常患者进一步检查,两者配合检查可提高诊断准确率.     

胃超声造影剂法对上消化道溃疡的诊断

目的：应用胃超声造影剂检测上消化溃疡。方法：采用“胃窗－８５超声造影剂化水量５００毫升口服后进行超声检查。结果：５６例超声检获胃溃疡２０例,十二指肠溃疡３６例。经手术病理,胃镜证实胃溃疡１７例,十二指肠溃疡３１例,Ｂ超误诊８例。Ｂ超诊断符合率分别赤８５％;８６％。结论：胃超声造影检查对上消化溃疡一定诊断价值     

小儿消化性疾病的胃电图变化及与临床特点和胃镜特征的关联性

目的:分析小儿消化性疾病的胃电图变化及与临床病理特征和胃镜特征的关联性。方法:选取2018年1月至2019年5月我院儿科收治的经胃镜和病理学两种方式诊断为消化性疾病的患儿54例为观察组,另选取无胃肠道疾病的健康儿童40例为对照组。比较两组胃电图参数(频率均值和波幅均值),54例胃电图诊断后纤维胃镜检查结果,分析消化性疾病患儿HP感染与临床病理特征、溃疡面积的关系。结果:各组胃病患者胃电慢波频率均值各不相同(P0.05),三组患者胃电慢波波幅均值相比差异具有统计学意义(P0.05);且浅表性胃炎组、胆汁反流性胃炎组患者胃电慢波频率均值、胃电慢波波幅均显著低于胃溃疡组(P0.05);浅表性胃炎组患者胃电慢波频率均值显著低于胆汁反流性胃炎组(P0.05)。胆汁反流性胃炎组患者胃电慢波波幅显著低于浅表性胃炎组(P0.05)。胃镜检查结果显示,其中浅表性胃炎的诊断符合率较高,达90.00%,胃溃疡符合率为60.71%,胆汁反流性胃炎符合率为83.33%。HP检测结果显示,HP阳性患儿占总例数的77.78%(42/54),HP阴性患儿占总例数的22.22%(12/54);HP阳性组患儿淋巴滤泡形成、胃黏膜萎缩、胃黏膜炎性活动的发生率明显高于HP阴性组,差异具有统计学意义(P0.01);HP阳性组溃疡范围2 cm的患儿比例明显高于HP阴性患儿,差异具有统计学意义(P0.01)。结论:小儿消化性疾病胃电图存在餐后NSWP的下降及节律过缓的上升,胃电图检查和胃镜检查在诊断上有较高的符合率,HP感染科引起胃黏膜组织学改变,可作为小儿消化性疾病的靶向治疗。     

胃肠间质细胞瘤12例分析

目的：探讨胃肠问质细胞瘤的诊断和治疗方法。方法：分析12例胃肠间质细胞瘤的临床表现、病理特点、诊断及治疗情况。结果：12例中,6例胃间质瘤,6例小肠问质瘤。主要症状为不规则腹痛、腹块、消化道出血。经胃镜、钡餐、CT检查发现。12例均行手术切除,病理证实诊断。9例随访,无复发,死亡。结论：胃肠问质细胞瘤大多为恶性或低度恶性,治疗以手术切除,术后严密随访。胃肠间质细胞瘤是指一类独立起源于胃肠道原始间质干细胞并呈非定向分化的间叶肿瘤。过去受病理诊断技术的限制,这类肿瘤多被诊断为平滑肌瘤、平滑肌肉瘤及神经纤维瘤。近年来随着病理诊断技术的进步,这类肿瘤被统一命名为胃肠道间质瘤(gastrointestinal stromal tumors,CLSTs)。我科自1995年至今收治胃肠道问质瘤12例。报告如下。     

超声内镜在上消化道黏膜下肿瘤诊断和鉴别诊断中的价值

目的:分析超声内镜(EUS)在上消化道黏膜下肿瘤(SMT)诊断价值。方法:选取我院收治的SMT患者81例,均进行EUS检查,且在院内进行内镜,或者手术治疗,将EUS诊断结果与术后的病理结果进行对比分析。结果:本组87处病变,经EUS诊断结果显示,平滑肌瘤35处,间质瘤36处,异位胰腺6处,脂肪瘤6处,类癌1处,囊肿1处,2处未做明确的诊断。经计算,EUS诊断SMT的阳性预测值79.31%,其中平滑肌瘤阳性预测值94.29%,间质瘤阳性预测值69.44%,异位胰腺阳性预测值83.33%,脂肪瘤阳性预测值66.67%。与术后病理诊断结果不符的EUS诊断病变共18处,诊断错误率20.69%,食管病变7处,胃病变10处,十二指肠病变1处。结论:EUS对上消化道SMT的诊断效果总体令人满意,但需要注意鉴别诊断,提高诊断准确率。     

常见消化道黏膜下肿物的临床特点及治疗方法

目的:探讨常见消化道黏膜下肿物(submucosal tumors,SMTs)的临床特点、治疗方式及安全性。方法:选择2014年5月至2016年3月在哈医大一院经内镜切除的并经病理及免疫组化明确诊断的消化道粘膜下肿物的患者共49例。所有患者术后3个月、6个月及12个月后随诊复查胃镜。统计每种肿物的患者临床症状,各种黏膜下肿物的性别分布、大小,及在消化道的分布。计算超声内镜的诊断率,总结病理结果。结果:49例患者中,间质瘤25例,类癌9例,平滑肌瘤8例,异位胰腺4例,脂肪瘤2例,颗粒细胞瘤1例。间质瘤分布以胃底、胃体多见。类癌以直肠最多见,胃内也可见。平滑肌瘤多分布于食管,也可见于胃。异位胰腺多分布于胃窦。通过内镜黏膜下挖除术(Endoscopic submucosal excavation,ESE)切除42例,粘膜下隧道切除术(Submucosal tunneling endoscopic resection,STER)切除4例,还有3例行内镜下黏膜切除(Endoscopic Mucosal Resection,EMR)。所有患者术后均无迟发性出血、严重感染及死亡病例发生。随访3-22个月,所有患者均无复发。结论:黏膜下肿物在内镜及超声内镜各有特点。超声内镜对黏膜下肿物的诊断与治疗具有重要的指导意义。双镜联合使SMTs的内镜下各种治疗方式(EMR、ESE、STER)更有安全保障,使患者受益最大。     

Cumulative sum procedure in evaluation of EUS-guided FNA cytology: the learning curve and diagnostic performance beyond sensitivity and specificity

Background: Using cumulative sum (CUSUM) chart, we address two questions: (i) Over time, how will an EUS‐FNA (endoscopic ultrasound guided fine needle aspiration) service maintain an acceptable non‐diagnostic rate defined as technical failures, unsatisfactory specimens and atypical and suspicious diagnoses? (ii) Over time, how will EUS‐FNA maintain acceptable diagnostic errors (false‐positives plus false‐negative diagnosis)? Methods: The study included all consecutive patients who underwent EUS‐FNA at our institution from July 2000 to October 2003 and were followed up until December 2004. Using a simple spread sheet, we designed CUSUM charts and used them to track trends and assess performance at a preset acceptable rate of 10% and a preset unacceptable rate of 15% for non‐diagnostic rate and diagnostic errors. We assessed all cases collectively and then in groups defined by site, size and cytopathologist. Results: Of 876 patients undergoing EUS‐FNA, 83 (9.5%) had non‐diagnostic results: 43 (51%) of these diagnoses were ‘atypical’, 27(33%) were ‘suspicious for malignancy’, eight (10%) were ‘insufficient material for diagnosis’ and five (6%) were ‘technical failure’. In 585 cases with adequate follow up, there were 26 (6.3%) diagnostic errors: three (0.5%) were false positive and 23 (3.1) were false negative. The overall CUSUM charts for both non‐diagnostic rate and for diagnostic error rate start with a small period of learning then cross to a significantly acceptable level at case numbers 121 and 97 respectively. Our diagnostic performance was better in lymph nodes than in the pancreas and other organs and was not significantly different for lesions ≤25 mm compared with lesion >25 mm in diameter. Performance was better for pathologists with prior experience than for pathologists without experience. Conclusion: In the current climate of proficiency testing, error tracking and competence evaluation, there is a great potential for the use of CUSUM charts to assess procedure failure and error tracking in quality control programs, particularly when a new procedure such as EUS‐FNA is introduced in the laboratory. Additionally, the method can be used to assess trainee competency and to track the proficiency of practicing cytologists.     

Outcomes of endoscopic ultrasound‐guided pancreatic FNAC diagnosis for solid and cystic lesions at Manchester Royal Infirmary based upon the Papanicolaou Society of Cytopathology pancreaticobiliary terminology classification scheme

Objective

To compare endoscopic ultrasound (EUS)‐FNAC diagnosis of pancreatic lesions with patient outcome based upon the Papanicolaou Society of Cytopathology pancreaticobiliary terminology classification scheme diagnostic categories: Panc 1 (non‐diagnostic); Panc 2 (negative for malignancy/neoplasia); Panc 3 (atypical); Panc 4B (neoplastic, benign); Panc 4O (neoplastic, other); Panc 5 (suspicious of malignancy); and Panc 6 (positive/malignant).

Methods

All EUS‐FNA pancreas specimens taken at Manchester Royal Infirmary in 2015 were prospectively classified according to the above scheme at the time of cytology reporting and data recorded prospectively. Subsequently, outcomes based on clinical follow‐up or histopathology diagnosis were compared with the cytology diagnosis.

Results

120 EUS‐FNA pancreas specimens from 111 patients were received, of which 112 (93.3%) specimens had follow‐up data. There were 79 and 41 EUS‐FNA pancreas specimens from solid and cystic lesions, respectively. Based on the cytology diagnosis the specimens were classified as Panc 1 (7.5%), Panc 2 (33.3%), Panc 3 (2.5%), Panc 4B (2.5%), Panc 4O (15.0%), Panc 5 (3.3%) and Panc 6 (35.9%). The performance indicators for diagnosis of malignancy or neoplasia with malignant potential, included sensitivity (95.4%), specificity (100%), positive predictive value (100%), negative predictive value (92.3%), false positive rate (0%) and false negative rate (4.6%).

Conclusions

The Papanicolaou Society of Cytopathology pancreaticobiliary terminology classification scheme is a logical system that can easily be introduced in a diagnostic cytopathology service. This classification scheme acts as an aid to diagnostic reporting, clear communication of significant results including risk of neoplasia/malignancy to clinicians, clinical audit and comparison of results with other centres.     

窄带成像技术联合放大内镜在早期胃癌诊断中的价值

目的:评估比较窄带成像技术联合放大内镜(narrow band imaging-magnifying endoscopy,NBI-ME)在早期胃癌诊断中价值。方法:115例早期胃癌患者行NBI-ME观察,采集照片并做出内镜下诊断,于病灶最明显处取活检并行病理检查。所有患者接受内镜下治疗,术后行病理活检。分别计算NBI-ME、内镜活检诊断早期胃癌的敏感度、特异度、阳性预测值、阴性预测值、准确率。结果:115例患者纳入本研究,最终术后切除病理示低级别上皮内瘤变(low-grade neoplasia,LGIN)16例,高级别上皮内瘤变(high-grade neoplasia,HGIN)30例,分化型胃癌59例,未分化型胃癌10例。NBI-ME诊断早期胃癌的敏感度、特异度、阳性预测值、阴性预测值、准确率分别为98.0%、81.3%、97.0%、86.7%、95.7%,内镜活检的对应值分别为82.8%、87.5%、97.6%、45.2%、83.5%。NBI-ME诊断早期胃癌的敏感度及准确率均明显高于内镜活检(P0.05)。结论:NBI-ME对早期胃癌具有较高诊断价值。     

Brush cytology of gastric malignancies

OBJECTIVE: To compare endoscopic biopsy and cytology versus biopsy alone in the diagnosis of gastric malignancies. STUDY DESIGN: This prospective study included 229 cases referred for endoscopy for visible gastric lesions during a four-year period (1996-2000). Both biopsy and brush cytology were performed, and all the slides were screened by a cytotechnologist and reviewed by a pathologist. RESULTS: Of the 229 cases, 97 (42.4%) were proven to be malignant and 132 (57.6%) definitely benign. Biopsy was positive in 90 patients (92.7%), while brush cytology was positive in 85 (87.1%). Combined use of biopsy and brush cytology yielded higher diagnostic sensitivity (100%). CONCLUSION: Brush cytology is a safe, easy and rapid method of diagnosing gastric malignancies. Brush cytology is a useful adjunct in the diagnosis of gastric malignancies and should be considered a routine method in combination with biopsy. Multiple repeated endoscopies are recommended in cases of positive cytology and negative biopsy to rule out or confirm malignancy.     

Contrast-Enhanced Harmonic Endoscopic Ultrasound-Guided Fine-Needle Aspiration in the Diagnosis of Solid Pancreatic Lesions: A Retrospective Study

Background

The negative predictive value of endoscopic ultrasonography-guided fine needle aspiration for the diagnosis of solid pancreatic lesions remains low, and the biopsy specimens are sometimes inadequate for appropriate pathological diagnosis.

Aims

To evaluate the usefulness of a novel method of contrast-enhanced harmonic endoscopic ultrasonography-guided fine-needle aspiration for the differential diagnosis and adequate sampling of solid pancreatic lesions.

Methods

Patients with a diagnosis of solid pancreatic lesions who underwent fine-needle aspiration guided by contrast-enhanced harmonic endoscopic ultrasonography or by endoscopic ultrasonography from October 2010 to July 2013 were retrospectively identified and classified into the CH-EUS or EUS group, respectively. Surgical pathology and/or follow-up results were defined as the final diagnosis. Operating characteristics and adequacy of biopsy specimens by fine-needle aspiration were compared between the two groups.

Results

Operating characteristics for contrast-enhanced harmonic endoscopic ultrasonography-guided fine-needle aspiration in solid pancreatic lesions were as follows: area under the curve = 0.908, sensitivity = 81.6%, specificity = 100%, positive predictive value = 100%, negative predictive value = 74.1%, and accuracy = 87.9%. The percentage of adequate biopsy specimens in the CH-EUS group (96.6%) was greater than that in the EUS group (86.7%).

Conclusion

Simultaneous contrast-enhanced harmonic endoscopic ultrasonography during fine-needle aspiration is useful for improving the diagnostic yield and adequate sampling of solid pancreatic lesions.     

小儿慢性胃炎内镜表现与胃黏膜病理组织学改变的相关性分析

目的：分析小儿慢性胃炎患儿内镜检查与病理组织学改变的相关性。方法：研究对象为本院自2010 年3 月至2013 年3 月收 治的186 例慢性胃炎儿童,均接受胃镜和病理学两种方式诊断,评价并分析镜下表现与病理学相关性。结果：经胃镜诊断结果为 178 例慢性浅表性胃炎（CSG）,8 例慢性萎缩性胃炎（CAG）。病理学诊断结果为170 例CSG,10 例CAG,6 例胃黏膜无损害。胃镜 与病理学诊断CSG 的准确度为90.32%,胃镜与病理学诊断CAG的准确度为93.54%。对CSG的阳性预测值中,红白间隔、红色 居多及充血水肿占92.42%和92.96%。病理组织学性的溃烂、活动性炎症、肠上皮化生与胃镜下各种表现的关系均不够密切。胃镜 与病理学诊断CSG和CAG 的灵敏度分别为97.06%和30.00%,差异具有显著性（P＜0.05）。结论：儿童CSG镜下主要形态对病理 诊断CSG 的灵敏性好且有相关性,而胃镜诊断CAG 对病理诊断CAG的灵敏性差。