超声内镜在上消化道粘膜下病变诊断及治疗价值  

Value of Endoscopic Ultrasonography in Diagnosis and Treatment of Submucosal Lesion of Upper Digestive Tract

作　　者：王艳[1] 张海燕[1] 鹿博[1] 吴明波[1] 周甜[1] WANG Yah;ZHANG Hai-yan;LU Bo;WU Ming-bo;ZHOU Tian(Digestive System Department,Xuzhou Central Hospital,Xuzhou,Jiangsu Province,221009 China)

机构地区：[1]徐州市中心医院消化内科,江苏徐州221009

出　　处：《系统医学》2018年第5期52-55,共4页Systems Medicine

基　　金：徐州市中心医院硕士创新团队课题;超声内镜在上消化道粘膜下肿瘤诊断及治疗方案选择的价值研究(XZS201675)

摘　　要：目的评价超声内镜在上消化道粘膜下病变诊断及治疗的价值。方法回顾性分析2013年1月—2015年5月该院收治行超声内镜的505例患者临床资料进行分析,以病理结果为诊断金标准,统计EUS对上消化道粘膜下病变诊断的准确性,根据超声内镜声像图选择不同治疗方案。结果上消化道粘膜下病变505例,超声内镜诊断平滑肌瘤229例,间质瘤67例,异位胰腺50例,外压性病变95例,囊肿24例,脂肪瘤24例,静脉瘤13例,纤维瘤3例,其中397例接受内镜或外科手术治疗,与术后病理结果比较,超声内镜诊断上消化道粘膜下病变的准确率为90.9%(361/397)。其中10例行鼠齿钳咬合术,64例行内镜下高频电切术,248例行内镜下粘膜切除术(EMR),39例行内镜下粘膜下剥离术(ESD),36例行腹腔镜或开腹手术,4例术中出现出血,3例术中给予钛夹止血,术后经药物保守治疗后出血停止,1例转外科行手术治疗后痊愈,6例术中发生微小穿孔,未出现死亡等严重并发症。结论超声内镜能够准确的判断上消化道粘膜下病变的性质及起源层次,对内镜下微创治疗有良好的指导作用,超声内镜在上消化道粘膜下病变的诊断及治疗发挥重要作用。Objective To evaluate the value of endoscopic ultrasonography in diagnosis and treatment of submucosal lesion of upper digestive tract. Methods 505 cases of patients treated with endoscopic ultrasonography in our hospital from January 2013 to May 2015 were selected, and the pathological results were diagnosis standards, and the accuracy of EUS in diagnosis of submucosal lesion of upper digestive tract was counted, and the treatment plan was selected according to the endoscopic ultrasonography features. Results There were 505 cases with submucosal lesion of upper digestive tract, the endoscopic ultrasonography diagnosis showed that there were 229 cases with leiomyoma, 67 cases with mesenchymoma, 50 cases with ectopic pancreas, 95 cases with external pressure lesions, 24 cases with cyst, 24 cases with lipoma, 13 cases with venous aneurysm, 3 cases with fibroma, and 397 cases received the endoscopic surgery or surgical operation, and the accurate rate of endoscopic ultrasonography in diagnosis and treatment of submucosal lesion of upper digestive tract was 90.9%（361/397）, and 10 cases underwent the occlusal of rat tooth forceps, 64 cases underwent high frequency electrocision under endoscopy, 248 cases underwent the EMR, and 39 cases underwent the ESD, 36 cases underwent the laparoscopic or laparotomy, 4 cases were with bleeding, 3 cases were with hemostasis with titanium clip, and the hemorrhage stopped after the conservative treatment, 1 case was converted to the department of surgery and cured, 6 cases had the small perforation, and no one died or had serious complications. Conclusion The endoscopic ultrasonography can accurately determine the nature and origin level of submucosal lesion of upper digestive tract, which is of guidance to the endoscopic minimally invasive treatment, and it is of major significance to the diagnosis and treatment of submucosal lesion of upper digestive tract.

关 键 词：超声内镜 上消化道 粘膜下病变 内镜下治疗 

分 类 号：R735.1[医药卫生—肿瘤]