DC是什么超声由表及里，由诊而治 ——超声内镜 Endoscopic ultrasound (EUS)

什么是超声内镜？

What is endoscopic ultrasound (EUS)？

超声内镜将内镜和超声技术结合，可以观察消化道及消化道周围的器官和组织。医生将细长的内镜经口或肛进入消化道，通过内镜头端的摄像头观察消化道管壁的情况。与内镜结合的超声探头通过超声波将探头周围的结构成像，不仅包括消化道管壁的各层组织，也包括消化道附近的结构和器官。因此超声内镜可以获得更多关于消化道的精细图像。超声内镜检查微创安全，可以门诊进行，绝大部分患者可以耐受。

Endoscopic ultrasound (EUS) combines two procedures: endoscopy and ultrasound to create images of the digestive tract and its surrounding organs and tissues. Endoscopy uses a long, thin tube, inserted into either the patient’s mouth or rectum, so the doctor can visualize the lining of the digestive tract endoscopically. Ultrasound uses sound waves to create images of the structure surround the probe, not only each layer of the digestive tract, but also its surrounding structures and organs. With these two technologies, your doctor can create more detailed images of the digestive tract. Endoscopic ultrasound is a minimally invasive, outpatient procedure and is well-tolerated by most people.

目前共有三种超声内镜系统：小探头，环扫超声内镜，线阵超声内镜。

There are three types of EUS: miniprobes, radial scope and linear scope. 

高分辨率超声小探头可以通过标准胃镜的2.8mm附件孔道。在评估食管、胃以及结直肠比较小的黏膜下病灶，浸润比较浅的早期肿瘤比如T1期食管癌等方面非常有用。

High-resolution ultrasound miniprobes can pass through the accessory channel of a standard 2.8mm endoscope. They are helpful when evaluating small, subepithelial lesions in the esophagus, stomach, colon and rectum, and when staging early cancers, such as T1 esophageal cancers. 

诊断较大病灶或者消化道周围的结构和器官，需要使用结合环扫或线阵超声探头的专用超声内镜。尽管两者成像不同，通过多普勒功能都可以区分血管和胰胆管等管道结构，也可以区分动脉和静脉。

For detecting large lesions or the surrounding structures and organs, EUS use special endoscope with radial or linear probe attached. Each scope gives a different view for the endoscopist, but both have Doppler capability to differentiate blood vessels from other ductal structures, and to tell the difference between arteries and veins. 

环扫超声内镜可以获得360°全周图像，如下图：

A radial scope is used to obtain a 360′ image and this is the picture the doctor sees:

线阵超声内镜可以获得楔形图像，如下图：

The linear scope gives a wedge-shaped image. The image using a linear scope looks like this:

上消化道超声内镜又称超声胃镜，探查范围包括食管，纵隔，胃，十二指肠，胰腺，部分肝脏和肾脏，胆囊，脾脏，左侧肾上腺和内镜所及消化道周围淋巴结。下消化道超声内镜又称超声肠镜，探查范围包括肛门及括约肌，直肠，结肠，膀胱，前列腺和周围淋巴结。

An “upper EUS” refers to an esophagogastroduodenoscopy with ultrasound. In this test, the doctor can visualize the esophagus, mediastinum, stomach, duodenum, pancreas, parts of liver and kidneys, gallbladder, spleen, left adrenal gland, and all surrounding lymph nodes.  A “lower EUS” usually refers to a colonoscopy with ultrasound. In this test, the doctor can view the muscle walls of the anal sphincters, the anus, rectum, colon, bladder, prostate and surrounding lymph nodes.

仁济医院消化内镜中心开展的诊治项目齐全，是本市最先开展ERCP、结肠镜单人操作以及食管扩张治疗等内镜诊治项目的单位之一。曾连续三次获得本市早期胃癌诊断例数评比第一名，在激光治疗消化道出血、肿瘤等方面保持国内领先水平，内镜年诊治数量达53000例次；是华东地区消化内镜培训基地。学科配备有专业的消化病理室以及目前世界一流的各种内镜设备和X线胃肠机，保证了内镜诊治的高质量。2006年完成对消化内镜中心的扩建，目前总面积达1300余平方米，近年来还开展了胶囊内镜、双气囊内镜、单气囊内镜、螺旋外套管式小肠镜、内镜窄带显像技术、自发荧光内镜诊断技术及对早期消化道癌的内镜下黏膜剥离术（ESD）等新项目。

Department of Digestive Endoscopy, Renji Hospital, carries out complete diagnosis and treatment projects and is one of the first units in Shanghai promoting ERCP, colonoscopic single operation and esophageal dilatation treatment. Our department had three consecutive years to rank first in diagnosis number of early gastric cancer, maintained the leading domestic level in the laser treatment of gastrointestinal bleeding and tumors(number of endoscopic diagnosis and treatment is 53000 cases per year), as well as being the digestive endoscopic training base in East China. In addition, our department is equipped with a professional digestive pathology room and a world-class variety of endoscopic equipments and X-ray gastrointestinal machines, ensuring the high accuracy of the endoscopic diagnosis and treatment. The digestive endoscopic center has been expanded in 2006 and the total area is 1,300 square meters at present. In recent years, our center is devoted in promoting capsule endoscopy, double balloon endoscopy, single balloon endoscopy, Spiral outer tube type enteroscopy, endoscopic narrowband imaging technique, auto-fluorescence endoscopic diagnosis technique and endoscopic mucosal dissection (ESD) for early gastrointestinal cancer and other new projects.

张尧是上海交通大学医学院附属仁济医院消化内镜中心副主任医师。中华医学会消化内镜学分会青年委员会委员，上海市中西医结合学会胰腺疾病专业委员会委员，上海市医学会消化系病专科分会胰腺学组成员。他擅长消化道早癌的内镜诊断和治疗（放大内镜，染色内镜，窄带成像技术，内镜下黏膜切除术，内镜黏膜下剥离术等）。同时熟练掌握球囊辅助小肠镜，静脉曲张套扎注射，狭窄扩张和支架置入等技术。目前专注于超声内镜及其相关技术领域的工作。

Dr. Zhang Yao is an associate chief physician of digestive endoscopy center of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. He works as a youth member of Chinese Medical Association digestive endoscopy session, member of Shanghai Chinese and Western Medicine Association of pancreatic disease specialized committee, member of Shanghai medical society of digestive disease pancreatic study group. Dr. Zhang is specialized in endoscopic diagnosis and treatment of early gastrointestinal cancer (magnifying endoscopy, dyeing technology，NBI, EMR, ESD, etc.). He is also skilled in the balloon assistant enteroscope, endoscopic variceal ligation and injection, endoscopic dilation and stent implant. Now he is focus on the area of endoscopic ultrasound and related techniques.

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仁济医院国际医疗

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