食管黏膜病变内镜介入诊治策略初步探讨  

The initial research of endoscopic diagnosis and treatment strategy for esophageal mucosal lesions

作　　者：朱宏[1] 施瑞华[1] 黄霞玥[1] 李学良[1] 于莲珍[1] 杨树平[1] 凌亭生[1] 丁霞芬[1] 丁静[1] 

机构地区：[1]南京医科大学第一附属医院消化内科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2010年第4期505-509,共5页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家十一五科技支撑计划"面向农村适宜推广项目"资助

摘　　要：目的:探讨内镜下联合卢戈氏液染色、超声微探头、氩离子凝固术(APC)、黏膜切除和黏膜剥除对食管黏膜病变的诊治价值。方法:①对常规胃镜发现的232例食管黏膜病变者采用内镜下卢戈氏液染色、超声微探头确定病变范围和深度;②多点活检获得病理诊断;③根据病理结果结合及染色内镜和超声内镜检查选择APC、高频电套切、黏膜切除或黏膜剥除予以治疗;④术后病理学复检并定期对治疗病例进行随访。结果:232例患者中有鳞状上皮乳头状增生35例、黏膜慢性炎34例、低级别上皮内瘤变54例、高级别上皮内瘤变58例、黏膜内癌31例、息肉20例。所有治疗病例均能顺利完成内镜下治疗,短期随访无复发(3～42个月)。结论:内镜下联合卢戈氏液染色、超声微探头、APC、黏膜切除和黏膜剥除的诊治策略对于食管黏膜病变的诊疗具有重要价值。Objective：To explore the diagnostic and therapeutic value of combination of endoscopic Lugol staining,miniprobe ultrasonography（MPS）,argon plasma coagulation（APC）,endoscopic mucosal resection （EMR） and endoscopic submucosal dissection（ESD） for esophageal mucosal lesions. Methods：①The measurement of range and depth of lesions,endoscopic Lugol staining and MPS were performed on 232 patients with esophageal lesions detected by routine endoscopy. ②Multi-point biopsies were collected to confirm the histopathologic diagnosis. ③APC,high-frequency knife,EMR and ESD were chosen to treat esophageal lesions according to their chromoendoscopy features,ultrasonography definitions and histopathologic findings.④Resected mucosal samples were histopathologically re-examinated and all patients were followed up for endoscopic examination periodically after the therapy. Results：232 cases were included：35 cases with squamocellular papillary hyperplasia;34 cases with chronic mucosal inflammation;58 cases with high-grade intraepithelial neoplasia;54 cases with low-grade intraepithelial neoplasia;31 cases with mucosal carcinoma and 20 cases with polyps. All intraepithelial neoplasia,mucosal carcinoma and polyp cases were endoscopic treated successfully and no recrudescence was found in short-term follow-up （3~42 months,average 21.6 months）. Conclusion：The strategy of combination of endoscopic Lugol staining,MPS,APC,EMR and ESD has a promising value on dignosis and treatment for esophageal mucosal lesions.

关 键 词：食管 染色内镜 超声微探头 黏膜切除 黏膜剥除 

分 类 号：R571[医药卫生—消化系统]