微探头超声内镜指导下ESD术对胃黏膜隆起性病变诊治的临床价值  

Clinical Value of ESD Guided by Mini-probe Endoscopic Ultrasonographyin the Diagnosis and Treatment of Gastric Mucosal Protrusion Lesions

作　　者：周祥荣[1] 徐大海[1] 彭清海 王飞 ZHOU Xiangrong;XU Dahai;PENG Qinghai(Jianyang People's Hospital,Sichuan Chengdu 641400,China)

机构地区：[1]四川省简阳市人民医院消化内科,四川简阳641400

出　　处：《河北医学》2020年第5期792-796,共5页Hebei Medicine

基　　金：四川省成都市医学科研课题,(编号:2017017)。

摘　　要：目的:探究微探头超声内镜指导下内镜黏膜下剥离术(ESD)对胃黏膜隆起性病变诊治的临床价值。方法:回顾性分析我院经手术病理学检查确诊的194例胃黏膜隆起性病变患者临床资料。分析微探头超声内镜与普通胃镜对胃黏膜隆起性病变诊断价值。并根据194例患者手术方式分为ESD组(n=102)及内镜下黏膜切除术(EMR)组(n=92),记录两组手术相关指标(整块切除率、手术时间、术中出血量)、并发症发生情况,比较两组术前及术后1d应激反应[去甲肾上腺素(NE)、皮质醇(Cor)]差异。结果:194例胃黏膜隆起性病变患者中息肉78例,间质瘤51例,平滑肌瘤42例,脂肪瘤23例;微探头超声内镜对胃黏膜隆起性病变诊断准确率明显高于普通胃镜(P<0.05)。ESD组整块切除率明显高于EMR组(P<0.05),手术时间、术中出血量则低于EMR组(P<0.05)。两组围术期并发症发生情况比较,差异无统计学意义(P>0.05)。术后1d时,两组应激反应(血清NE、Cor)均较术前升高(P<0.05),且EMR组高于ESD组(P<0.05)。结论:微探头超声内镜指导下ESD对胃黏膜隆起性病变诊治效果显著,还能降低手术应激反应,对于促进患者术后恢复有积极意义。Objective:To investigate the clinical value of endoscopic submucosal dissection(ESD)guided by mini-probe endoscopic ultrasonography in the diagnosis and treatment of gastric mucosal protrusion lesions.Methods:The clinical data of 194 patients with gastric mucosal protrusion confirmed by operation and pathology were analyzed retrospectively.The diagnostic value of micro probe endoscopic ultrasonography and general gastroscopy in gastric mucosal protuberant lesions were analyzed.194 patients were divided into ESD group(n=102)and EMR group(n=92)according to the operation mode.The operation related indexes(whole resection rate,operation time,intraoperative bleeding volume)and complications were recorded.The difference of stress response(noradrenaline(NE),cortisol(COR))between the two groups before and 1 day after operation was compared.Results:Of the 194 patients with gastric mucosal protrusion lesions,there were 78 cases of polyps,51 cases of interstitialoma,42 cases of liomyoma and 23 cases of lipomyoma.The diagnostic accuracy rate of mini-probe endoscopic ultrasonography was significantly higher than that of common gastroscopy in the diagnosis of gastric mucosal protrusion lesions(P<0.05).The block resection rate in ESD group was significantly higher than that in EMR group(P<0.05),and the surgery time and intraoperative blood loss were lower than those in EMR group(P<0.05).There were no significant differences in the perioperative complications between the two groups(P>0.05).At 1d after surgery,the stress response indexes(serum NE,Cor)were higher than those before surgery(P<0.05),and the indexes in EMR group were higher than those in ESD group(P<0.05).Conclusion:ESD by mini-probe endoscopic ultrasonography has significant effects in the diagnosis and treatment of gastric mucosal protrusion lesions,and can reduce the surgical stress response,and it is of positive significance in promoting postoperative recovery.

关 键 词：胃黏膜隆起性病变 微探头超声内镜 内镜黏膜下剥离术 整块切除 

分 类 号：R656.61[医药卫生—外科学]