小探头超声内镜对上消化道黏膜下病变诊断及个体化治疗的价值  

The value of miniprobe endoscopic ultrasonography in diagnosis and individualized treatment of upper gastrointestinal submucosal lesions

作　　者：王炘[1] 詹志刚[1] WANG Xin;ZHAN Zhi-gang(Department of Gastroenterolog, tfie 907" Hospital of PLA , Nanping 353000, Fujian, China)

机构地区：[1]中国人民解放军联勤保障部队第907医院消化内科

出　　处：《广东医学》2019年第18期2615-2618,共4页Guangdong Medical Journal

基　　金：青年培育项目(编号:14MS078)

摘　　要：目的探讨小探头超声内镜(mEUS)对上消化道黏膜下病变的诊断及指导个体化治疗方案选择的价值。方法将经mEUS检查的80例上消化道黏膜下病变患者纳入研究,依据检查结果所提示的病灶起源层次、性质及大小选择个体化的内镜治疗方案,术后标本送病理检查。结果 80例患者中,病变起源于黏膜肌层30例,黏膜下层28例,固有肌层22例;考虑为平滑肌瘤27例,间质瘤25例,囊肿6例,类癌3例,异位胰腺12例,脂肪瘤5例,颗粒细胞瘤2例。其中起源于黏膜肌层的病变采用内镜下黏膜切除术(EMR)或内镜黏膜下剥离术(ESD),起源于黏膜下层的病变采用ESD,起源于固有肌层的病变采用内镜黏膜下挖除术(ESE)或内镜经黏膜下隧道肿瘤切除术(STER),对于考虑囊肿的病变采用内镜下穿刺或Dual刀切开囊壁治疗。mEUS扫查结果与病理诊断的符合率为93.75%。结论 mEUS可准确判断上消化道黏膜下病变的大小、起源和性质,指导个体化内镜治疗方式的选择,避免内镜治疗术中、术后大出血、穿孔等风险的发生。Objective To investigate the application of miniprobe endoscopic ultrasonography(mEUS) in diagnosis and individualized treatment of upper gastrointestinal submucosal lesions. Methods Eighty cases of upper gastrointestinal submucosal lesions examined by mEUS in the 907th hospital of PLA from January 2018 to September 2018 were included. Individualized endoscopic treatment was selected based on origin level, nature and size of the lesions according to mEUS. All specimens were sent for pathological examination. Results Among the 80 cases, 30 cases were detected in muscularis mucosae, 28 cases in submucosa and 22 cases in muscularis propria. Twenty-senven cases were diagnosed as leiomyoma, 25 as gastrointestinal stromal tumors(GIST), 6 as cyst, 3 as carcinoid, 12 as heterotopic pancreas, 5 as lipoma, and 2 as granular cell tumor. The lesions derived from muscularis mucosae received endoscopic mucosal resection(EMR) or endoscopic submucosal dissection(ESD);lesions derived from submucosa were treated by ESD;and lesions derived from muscularis propria were treated by endoscopic submucosal extirpation(ESE) or submucosal tunnel endoscopic resection(STER). The lesions considered as cyst were treated by endoscopic puncture or Dual knife cutting therapy. The coincidence rate between mEUS scanning and pathological diagnosis was 93.75%. Conclusion Miniprobe endoscopic ultrasonography can accurately estimate the size, origin level and nature of upper gastrointestinal submucosal lesions, and guide the choice of individualized endoscopic therapy, which will avoid the risk of massive hemorrhage and perforation during and after endoscopic treatment.

关 键 词：小探头超声内镜 黏膜下病变 内镜治疗 

分 类 号：R574[医药卫生—消化系统] R445.1[医药卫生—内科学]