超声内镜在消化疾病中的临床应用(2015)教学提纲.ppt

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1、超声内镜在消化疾病中的临床应用(2015)EUS诊断EUS经历了三个重要阶段EUS穿刺活检（EUS-FNA）EUS注射治疗（EUS-FNI）构成超声内镜类型超声内镜在临床中的应用粘膜下病变Subepitheliallesions胆总管结石Choledocholithiaisis胆管狭窄Bileductstrictures胰腺囊性和实质性病变Pancreaticcysticandmasslesions胰管狭窄Pancreaticductstrictures神经内分泌瘤定位Localizationofneuroendocrinetumours纵隔病变Mediastinallesi

2、ons诊断评价Diagnosticevaluation癌症分期Cancerstaging食道癌EsophagealCancer胃癌GastricCancer直肠癌RectalCancer胆管癌Cholangiocarcinoma胰腺癌PancreaticCancer肺癌lungCancer正常胃壁的超声图像特征第1层：粘膜层第2层：粘膜肌层第3层：粘膜下层第4层：固有肌层第5层：浆膜层胃溃疡回声缺损。声像图上表现为弧形或盘状凹陷。陈XX，男，61中上腹饥饿痛王XX，男，64y中上腹痛早期胃癌超声内镜的检查李XX，男，50粘膜和粘膜下层呈不规则增厚层次结构紊乱，内部回声不均。进

3、展期胃癌的EUS声像图特点肿大淋巴结腹水黄XX，男，64结构破坏，增厚；不规则低回声；BorrmannIV型胃癌项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术前T、N分期对外科手术时期、方式的选择，判断预后等具指导意义超声内镜能做到术前T、N分期，其敏感性和特异性高于CT、MRI等检查EUSstagingEUSstagingNo.AuthorYearofNo.ofTypeofConfirmatorypublicationpatientsstudyprocedure1Grimmetal1993147ProspectiveSurgery2Francois

4、etal199629ConsecutiveSurgery3Schimizuetal1994125ConsecutiveSurgery4Dittleretal1993254ConsecutiveSurgery5Ziegleretal1993118ProspectiveSurgery6Botetetal199150ProspectiveSurgery7Xietal200335ProspectiveSurgery8Calettietal199142ProspectiveSurgery9Akahoshietal198974ProspectiveSurgery10Tioetal1989

5、72ProspectiveSurgery11Massarietal199699ProspectiveSurgery12Saitoetal1991110ProspectiveSurgery13Murataetal1988146ProspectiveSurgery14Hunerbeinetal199619ConsecutiveSurgery15Perngetal199669ConsecutiveSurgery16Tioetal198975ProspectiveSurgery17Tioetal198636ProspectiveSurgery18Shimoyamaetal200445

6、ConsecutiveSurgery19Willisetal2000116ConsecutiveSurgery20Roschetal199241ConsecutiveSurgery21Javaidetal2003112ConsecutiveSurgery22Potrcetal200682ProspectiveSurgery22项研究，1896名患者术前T、N分期分析sensitivityspecificityPooledDORT188.1%(84.5-91.1)100.0%(99.7-100.0)605.6(296.8-1235.6)T282.3%(78.2-86.0)95.

7、6%(94.4-96.6)108.6(56.6-208.1)T389.7%(87.1-92.0)94.7%(93.3-95.9)144.4(95.4-218.7)T499.2%(97.1-99.9)96.7%(95.7-97.6)507.8(247.5-1042.1)N158.2%(53.5-62.8)87.2%(84.4-89.7)9.5(5.3-16.9)N264.9%(60.8-68.8)92.4%(89.9-94.4)26.6(13.9-50.7)EUS与CT检查比较CT检查可显示胃癌累及胃壁向