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[目的]探讨超声内镜(EUS)对术前结直肠黏膜活检为高级别上皮内瘤变(HGIN)的浸润深度判定的准确性。[方法]选取86例结直肠黏膜活检结果为高级别上皮内瘤变患者,术前行EUS检查初步判断病变浸润深度,根据EUS术前分期的结果指导行黏膜下剥离(ESD)或外科手术治疗。观察术后病理结果,比较EUS对病变浸润深度判断的准确率。[结果]86例患者术前EUS示4例为单纯HGIN,20例考虑为早期结直肠癌,其中有17例行ESD,7例选择行外科手术,21例EUS诊断与术后病理检查病变浸润深度符合,62例EUS诊断为进展期结直肠癌,对其行外科手术治疗,59例EUS诊断与术后病理检查病变浸润深度符合,EUS的对HGIN的诊断特异度、敏感性、阳性预测值、约登指数、一致率分别为87.50%、95.16%、87.59%、82.66%、93.02%。对扁平的病变EUS诊断准确率为95.92%。[结论]结直肠HGIN术前的EUS检查,对病变浸润深度具有较高的准确性,对手术方式的选择具有一定的指导意义。
[Objective] To investigate the accuracy of endoscopic ultrasonography (EUS) in determining the depth of invasion of preoperative colorectal mucosa as high grade intraepithelial neoplasia (HGIN). [Methods] Totally 86 patients with high grade intraepithelial neoplasia were selected for biopsy of colorectal mucosa. The depth of invasion was preliminarily determined by EUS preoperatively and submucosal dissection (ESD) or surgical operation was guided according to the results of preoperative EUS staging. . The postoperative pathological results were observed, and the accuracy of EUS in determining the depth of invasion was compared. [Result] Among the 86 patients, 4 cases were HGIN only, 4 cases were considered as HGIN, 20 cases were considered as early stage colorectal cancer. Among them, 17 cases underwent ESD, 7 cases underwent surgical operation, 21 cases had EUS diagnosis and postoperative pathological changes 62 cases of EUS were diagnosed as advanced colorectal cancer, and their surgical treatment was performed. The depth of infiltration of EUS in 59 cases and postoperative pathological examination was consistent with the specificity, sensitivity, positive predictive value of EUS for HGIN , Youden index, the agreement rates were 87.50%, 95.16%, 87.59%, 82.66%, 93.02% respectively. The diagnostic accuracy of flat lesions EUS was 95.92%. [Conclusion] The EUS examination of HGIN before colorectal surgery has a high accuracy for the depth of invasion of the lesion, which is of guiding significance for the choice of surgical approach.