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目的评估小肠腔内超声(ISIU)检查对小肠疾病诊断的价值及可行性和安全性。方法对2004年6月至2005年2月间11例因不明原因慢性腹泻、隐性出血及腹痛怀疑小肠疾病的患者行双气囊小肠镜(DBE)检查,发现局部病灶或病变肠段后,经DBE活检孔道插入特制超声小探头进行 ISIU探查,取得正常肠壁以及局部病灶或病变肠段ISIU影像图并对其进行分析。结果 11例患者中, DBE发现阳性病灶并行ISIU检查9例,其中成功完成ISIU探查者8例,平均用时20 min。提示侵犯浆膜层的恶性肿瘤2例(术后病理证实),表现为小肠绒毛层消失,其余小肠壁层次破坏,代之以不均低回声区域;小肠间质瘤1例(起源于肌层,术后病理证实),表现为边界清晰的均匀低回声区域内伴有部分高回声;肠壁黏膜层来源息肉1例(活检证实),影像特征为均匀高回声区域;早期克罗恩病2例,表现为小肠绒毛层消失,其余肠壁层次模糊伴全层小肠壁增厚;淋巴管瘤1例,表现为内伴管样结构的均匀中低回声区域;对于DBE发现的小肠毛细血管扩张症患者,ISIU影像不能明确诊断。另有1例DBE发现增殖性病灶的患者,由于病灶位置较深,位于空回肠交界部,经口DBE中超声小探头不能经由内镜活检孔道送出导致探查失败。所有ISIU探查均未发现相关的并发症。结论 ISIU是一种安全有效的辅助检查手段,尤其对小肠黏膜下肿瘤的性质鉴别、早期克罗恩病的诊断及肿瘤侵犯深度的判断存在明显优势。
Objective To evaluate the value, feasibility and safety of small intestine ultrasound (ISIU) in the diagnosis of small intestinal diseases. Methods From June 2004 to February 2005, 11 patients with suspected small intestine disease due to unknown causes of chronic diarrhea, occult bleeding and abdominal pain underwent double balloon enteroscopy (DBE). After finding the local lesion or the diseased bowel segment, DBE biopsy hole insertion of a small special ultrasound probe for ISIU exploration to obtain the normal intestinal wall and lesions or lesion intestinal ISIU image and analysis. Results Among the 11 patients, 9 cases were found positive for DBE by ISIU and 8 cases were successfully completed by ISIU, with an average of 20 minutes. Prompt violation of serosal malignancies in 2 cases (pathological confirmed), the performance of the villi disappear, leaving the rest of the small intestinal wall damage, replaced by uneven hypoechoic area; 1 case of intestinal stromal tumors (originated in the muscular layer , Postoperative pathology confirmed), the performance of the border clear uniform hypoechoic region accompanied by some hyperechoic; intestinal mucosa from polyps in 1 case (biopsy confirmed), the image features a homogeneous hyperechoic region; early Crohn’s disease 2 Cases, the performance of the villi disappeared, leaving the other layers of the intestinal wall with fuzzy thick layer of intestinal wall thickening; lymphangioma in 1 case, showed a uniform low-echogenic duct-like structure of the region; for the discovery of DBE small bowel telangiectasia Symptomatic patients, ISIU images can not be clearly diagnosed. Another case of proliferative lesions found in DBE patients, due to the location of the lesion is located in the junction of the ileum, oral DBE small ultrasound probe can not be sent through the endoscopic biopsy channel lead to failure of the exploration. All ISIU exploration found no associated complications. Conclusion ISIU is a safe and effective auxiliary examination method. Especially for the characterization of small intestinal submucosal tumors, the diagnosis of early Crohn’s disease and the judgment of tumor invasion depth have obvious advantages.