电子超声内镜在食管黏膜层及黏膜下病变诊疗中的作用  

Role of endoscopic ultrasonography in the treatment and diagnosis of esophageal mucosal and submucosal tumors

作　　者：冯珊珊[1] 姜军梅[1] 刘吉勇[1] 杨崇美[1] 张俊勇[1] 张安忠[1] 王冠华[1] 许诺[1] 

机构地区：[1]山东大学附属省立医院消化内科,济南250021

出　　处：《山东大学学报（医学版）》2012年第7期97-100,104,共5页Journal of Shandong University:Health Sciences

摘　　要：目的探讨电子超声内镜(endoscopic ultrasonography,EUS)结合内镜下黏膜切除术(endoscopic mucosalresection,EMR)、内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)、内镜黏膜下挖除术(endoscopicsubmucosal excavation,ESE)及外科手术在食管黏膜层及黏膜下病变诊断和治疗中的作用。方法对2010年1月至2012年1月常规电子内镜检查发现食管黏膜层及黏膜下病变行EUS检查患者118例共120处病灶。将EUS拟诊诊断与内镜下手术及外科手术术后病理结果(包括病理类型、起源)进行统计分析,分析其符合率。结果黏膜层病变术后病理与EUS拟诊符合率为100%(16/16),分层诊断准确率为93.75%(15/16);黏膜下病变术后病理与EUS拟诊符合率为88.5%(92/104),分层诊断准确率为97.1%(101/104);本研究中,所有病变术后病理与EUS拟诊的总体符合率为90%(108/120),总体分层诊断准确率为96.7%(116/120)。结论 EUS能准确地显示食管各层结构、判断肿瘤的起源,较准确地估计肿瘤的性质。对于食管肿瘤治疗方式的选择、扩大内镜下手术治疗适应证、指导外科手术治疗,均能起到较好的作用,应在治疗前常规应用。对黏膜下病变,提倡在EUS的指导下进行早期干预。Objective To study the roles of endoscopic ultrasonography combining with endoscopic mucosal resection, endoscopic submucosal dissection, endoscopic submucosal excavation and surgery in the treatment and diagnosis of esophageal mucosal and submucosal tumors. Methods A total of 120 lesions in 118 patients during the period between January 2010 and January 2012 were involved in the study. Esophageal mucosal and submucosal tumors observed by conventional endoscopy were detected by EUS. EUS image findings were compared with endoscopic and surgical post- operative pathological results （ including pathological type and origin） for statistical analysis of accuracy rates. Results According to the pathological results, the diagnostic accuracy rate of EUS image findings for mucosal tumors was 100% （ 16/16）, the accuracy rate of EUS origin layer was 93.75% （15/16）. The diagnostic accuracy rate of EUS im- age findings for submucosal tumors was 88.5% （92/104）, the accuracy rate of EUS origin layer was 97.1% （101/ 104）. The total diagnostic accuracy was 90% （108/120） and the total EUS origin layer accuracy rate was 96.7% （116/120） in this study. Conclusion EUS is an accurate techinque for detecting the esophageal＇s structure layers, determining the tumor origin and estimating the tumor biological behavior. Therefore EUS findings can be one of themost important keys for choosing the treatment methods of the lesions, expanding the endoscopic treatment indications and guiding the surgical operations. So it should be applied commonly and SMTs should be treated early with the help of EUS.

关 键 词：电子超声内镜 内镜黏膜下剥离术 内镜下黏膜切除术 内镜黏膜下挖除术 食管肿瘤 

分 类 号：R445[医药卫生—影像医学与核医学] R571[医药卫生—诊断学]