课件：超声内镜临床应用讲稿.ppt

* 經過兩次CT Scan未能分別是否腫瘤. Colonscopy showed possible submuscosal mass. Finally, EUS together with FNA has proven that is colon carcinoma. 胆管系统肿瘤的诊疗 FREQ:7.5MHz FREQ:20MHz FREQ:7.5MHz 肿瘤 胰腺 头部 胆囊 EUS引导下 穿刺活检： 不同方法对总胆管肿瘤诊断的比较 肿瘤?20mm n % 肿瘤?20mm n % Total n % EUS 12 100 9 100 21 100 US 4 33 5 58 9 43 CT 4 33 6 67 10 48 ERCP 12 100 9 100 21 100 Angio 4 33 8 89 12 57 (Tanaka, 1998) 超声探头对胆管肿瘤浸润的诊断 管内超声诊断 (IDUS) 纤维肌层層 浆膜下层 浆膜层 病理诊断 纤维肌层 1 浆膜下层 4 浆膜层 2 6 准确度：84.6% UM-4R(20MHz) (Inui et al., 1998) EUS对胃食管静脉曲张的诊断 曲张静脉通常于第2、3层中可见低回声影像呈椭圆形和长形，第1、2层之间有时可见低回声小圆形影像为红色征的扩张小静脉。硬化治疗后，则原曲张静脉腔的低回声变为高回声区。 食道静脉曲张 EUS在皮革胃中的诊断价值 皮革胃 系一特殊类型进展期胃癌，即弥漫浸润型Borrmann IV胃癌、胃镜诊断较为困难肿瘤组织多呈弥漫性浸润生长，先累及粘膜下层，再沿胃凹壁周围浸润扩散，早期粘膜形态学缺乏特异性变化，易与胃炎相混淆。 EUS检查则可发现胃壁不规则明显增厚，层次结构弥漫性破坏，主要位于黏膜下层和固有肌层，而黏膜层及黏膜肌层尚完整，说明病变系沿着粘膜下浸涧生长。 淋巴瘤及胃癌 超声内镜在大肠疾病中的应用 直肠肿瘤的诊疗 浸润到浆膜层 的T3肿瘤 直肠内病变 组织 FREQ:7.5MHz 黏膜下层病变的诊疗：大肠癌 FREQ:7.5MHz FREQ:12MHz EUS引导下 穿刺活检： FREQ:7.5MHz 直肠 乙状结肠 黏膜下层 肿瘤 CTx2 NEG EUS的前景 EUS安全性较高，患者耐受性较好，尤其在消化系统各种良恶性疾病的诊断，定位中较其他各项传统检测手段具有明显的优势，故有着较好的研究和推广前景，将超声内镜与镜下活检两种原本独立的方法结合起来，以强化EUS的优势，成为目前 EUS技术发展中最令人感兴趣的问题之一。 超声内镜在指导内镜下的治疗目前已在临床上开始应用。相信随着EUS的广泛应用，将对消化道疾病的诊断及治疗起到更大的作用。 * * * * * * * Endoscopic inspection showed large submucosal mass in the proximal stomach. EUS showed a homogeneous submucosal tumor arising from muscularis propria. FNA showed benign leiomyoma. * * ERCP showed dilated CBD and PD. EUS with FNA diagnosed carcinoma of head of pancreas and staged T2. This staging was subsequently confirmed after surgical resection. * * * * * * EUS showed a mass in the neck of the gallbladder consistent with a T3 carcinoma. However, there were also some celiac nodes. FNA was performed on the celiac node yielding adenocarcinama. Since this made the patient unresectible, the patient was taken directly to ERCP for stent placement to palliate her biliary obstruction. * * * CT scan of abdomen and pelvis was normal. EUS showed hypoechoic tumor infiltration through muscularis prop