目的探讨超声内镜(EUS)在诊断消化系统神经内分泌肿瘤的价值。方法对确诊为消化系统神经内分泌肿瘤的16例患者临床资料进行回顾性分析,探讨其EUS表现,并与传统影像学诊断方法进行比较,了解其诊断价值。结果共16例神经内分泌肿瘤,7例(43.8%)神经内分泌肿瘤发生在胰腺:肿瘤位于胰腺头部2例,胰腺体部2例,胰腺尾部2例,胰腺头部-体部交界处1例;EUS特点:边界清楚,圆形或类圆形的低回声肿块,其内部回声可均匀或不均匀,部分可在肿块周边发现晕环样改变(不连续的高回声边缘)。6例(37.5%)发生在直肠(平均距肛门5.5 cm),EUS特点:起源于黏膜或黏膜下层的回声均匀的低回声肿块。2例(12.5%)发生胃部,EUS特点:起源于黏膜层或黏膜下层,内部回声均匀或不均匀的等或低回声病变。1例(6.2%)发生在左肾上腺,EUS特点:内见分隔带的无回声影,壁厚,回声较高。所有患者最终均经病理确诊为神经内分泌肿瘤,其中有7例经手术后得到确诊,3例经内镜下黏膜剥离术得到确诊,2例经EUS-FNA得到确诊,2例经EMR得到确诊,术前EUS诊断正确率为93.7%。结论 EUS可用于胰腺神经内分泌肿瘤的术前定位、诊断和指导消化道类癌的内镜下治疗,并通过EUS-FNA提取病理组织进行细胞学诊断,优于传统的影像学方法,是消化系统神经内分泌肿瘤的重要诊断手段。
Objective To assess the diagonostic value of EUS forGI tract neuroendocrine tumors. Methods 16 cases of neuroendocrine tumors diagnosed at the First Affiliated Hospital of Guangxi Medical University from December 2002 to December 2012 were retrospectively analyzed. The feature of the EUS imaging was compared with traditional diagnostic method and evaluated the diagnostic value. Result Of the 16 Neuroendocrine tumors,7 ( 43. 8%) were in the pancreas: two in the pancreatic head,two in the pancreatic body,two in the pancreatic tail,one in the junction of head and body) . On EUS,pancreatic neuroendocrine tumors presented as hypoechoic masses with clear margins and maybe halo-like changes ( discontinuous hyperechoic edge) . Of the 16 Neuroendocrine tumors,6( 37. 5%) were in the rectum( mean 5. 5 cm) . On EUS,rectal carcinoid presented as hypoechoic masses with clear margins in mucosal or submucosal lesions. Of the 16 Neuroendocrine tumors,2 ( 12. 5%) were in the stomach. On EUS,it presented as hypoechoic masses in mucosal or submucosal lesions. 1( 6. 2%) was in the left adrenal gland and it presented as anechoic shadow with median strip and thick wall in the left adrenal. 15 neuroendocrine tumors all were definitely diagnosed by pathology. 7 underwent surger; 3 underwent ESD; 2 underwent EUS-FNA; 2 underwent EMR. The accuracy rate of EUS for preoperative localization was 93. 7%. Conclusion EUS can provide accurate preoperative localization and pathologic evidence for pancreatic neuroendocrine tumors. EUS has the the value in diagnosis and guiding EMR for enteron carcinoid.