超声内镜辅助内镜黏膜切除术治疗食管黏膜肌层病变的临床分析  

Clinical analysis of endoscopic mucosal resection with guided endoscopic ultrasonography on esophageal subepithelial lesions originating from muscularis mucosa

作　　者：刘晓岗[1] 李易[1] 李良平[1] 阳运超[1] 张仁翼[1] 周丽华[1] 

机构地区：[1]四川省人民医院消化内科,四川成都610072

出　　处：《胃肠病学和肝病学杂志》2013年第1期40-42,共3页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的回顾分析内镜下黏膜切除术(endoscopic mucosal resection,EMR)对食管黏膜肌层病变的治疗效果,并讨论其并发症和随访结果。方法 40例经超声内镜小探头证实的食管黏膜肌层病变,以注射法行黏膜切除治疗,记录病变大小、超声所见、操作方法、并发症、术后病理类型及随访情况。结果 40处病变经EMR完整切除,一次性完整切除率95.0%(38/40)。并发症:术中创面少许渗血7例(17.5%),均以氩气刀止血成功,无搏动性出血及穿孔发生。无迟发性出血及穿孔发生。术后病理:平滑肌瘤32例,间质瘤3例,炎性肉芽肿3例,血管瘤2例。随访1～12个月,未见病变残留或复发。结论超声内镜联合内镜黏膜切除术,术后常规行免疫组化检查,可完整切除食管黏膜肌层病变,方法安全有效。To analyze the safety, curative effect of endoscopic mucosal resection （EMR） on esophageal subepithelial lesions originating from muscularis mucasa respectively. Methods 40 cases of esophageal subepithelial lesions originating from muscularis mucosa were confirmed by mini probe of endoscopic uhrasonography （EUS） , and resected by injection-assisted EMR. Techiques and complications were recorded. Diameter and uhrasonography findings of above lesions were recorded. All resected specimen were retrieved for pathological study. All cases were enrolled for endoscopic follow-up. Results 40 subepithelial lesions were completely resected by EMR, and disposable completly endoscopie resection rate achieved 95.0% （38/40）. The only acute complication was mild bleeding, occurred in 7 cases （17.5%）, which was managed by argon plasma coagulation （APC）. No pulsative bleeding or acute perforation occured. No delayed hemorrhage occurred. The post-EMR pathological finding included 32 cases of leiomyoma, 3 cases of gastrointestinal stromal tumors （GISTs） , 3 cases of inflammatory granuloma and 2 eases of angioma. The endoscopic follow-up （from 1 to 12 months） showed no recurrence or residual of lesions. Conclusion EMR assisted by EUS could completely and safely resect the esophageal subepithelial lesions originating from muscularis mucosa, the immunohistochemistry after procedure is routinely recommended.

关 键 词：超声内镜 内镜黏膜切除术 食管 黏膜肌层 病变 免疫组化 

分 类 号：R571[医药卫生—消化系统]