基于EUS引导下ESD对食管上皮下鱼刺的治疗  

Therapeutic value of EUS-guided ESD resection of subepithelial fish bones in esophagus

作　　者：曹友红 吕翔 张康伟 袁晨 徐甜 唐月华 马亦旻 邢一鸣 张以洋 Cao Youhong;Lv Xiang;Zhang Kangwei;Yuan Chen;Xu Tian;Tang Yuehua;Ma Yimin;Xing Yiming;Zhang Yiyang(Department of Gastroenterology,NanJing Gaochun People's Hospital,Gaochun 211300,China;Department of Geriatrics,NanJing Gaochun People,s Hospital,Gaochun 211300,China;Department of Gastroenterology,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京市高淳人民医院消化科,江苏高淳211300 [2]南京市高淳人民医院老年科,江苏高淳211300 [3]南京大学附属鼓楼医院消化科,南京210008

出　　处：《中华胃肠内镜电子杂志》2024年第4期243-247,共5页Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition)

基　　金：江苏大学医教协同创新基金项目(JDYY2023033)

摘　　要：目的研究超声内镜(EUS)引导探查下实施内镜黏膜下剥离术(ESD)对取除误吞刺入食管上皮下鱼刺(鱼骨)的治疗价值及效果分析。方法回顾性收集2017年1月至2024年3月经南京市高淳人民医院消化科急诊诊断为食管异物(鱼刺)刺入上皮下9例患者,行相关普通胃镜及超声胃镜检查后,确认刺入食管上皮层以下食管管腔内。结果9例患者,男3例、女6例,自刺入至就首次诊时间在(2~72 h);CT显示异物嵌段为食管上段8例、下段1例;主要临床表现为咽后、胸骨后异物感明显、咽后疼痛、胸骨后疼痛;术前EUS提示异物主体位于黏膜肌层2例、位于黏膜下层5例、位于固有肌层2例;9例患者均顺利经EUS引导下行ESD寻找到刺入黏膜内鱼刺并取出,中位手术时间为22.33(9~45)min,术中探查见异物鱼刺距门齿16~22 cm(上段8/9),距门齿38 cm(下段1/9);刺入鱼刺嵌入深度:黏膜层内2例(2/9)、黏膜下层5例(5/9)、固有肌层内2例(2/9),其中深达食管腔外1例。术前及术中确诊有局部小穿孔2例(2/9)、术中局部创面有明显出血2例(2/9),术后住院时间为3.67 d(2~7 d);术后随访时间为41.39个月(9~86个月)均无明显不适,一般情况可。结论EUS引导探查下实施ESD对取出食管上皮下的鱼刺安全有效,可成为新的针对食管上皮下鱼刺的异物取出微创方法,具有良好的临床应用及推广价值。Objective To investigate the therapeutic value and efficacy of performing ESD guided by EUS for the removal of subepithelial fish bones in esophagus.Methods A total of 9 patients diagnosed with esophageal foreign body(fish bone)embedded in the submucosa in our emergency department from January 2017 to March 2024 were retrospectively collected.After relevant conventional gastroscopy and endoscopic ultrasonography examinations,it was confirmed that the foreign bodies were embedded below the esophageal mucosa.Results Among the 9 patients with submucosally embedded foreign bodies in the esophagus,there were 3 males and 6 females,with the time of embedding ranging from 2 to 72 hours;CT scans showed that the foreign bodies were lodged in the upper segment of the esophagus in 8 cases,and in the lower segment in 1 case;the main clinical manifestations included a clear sensation of foreign body behind the pharynx and sternum,pharyngeal pain,and retrosternal pain;preoperative endoscopic ultrasonography suggested that the foreign bodies were mainly located in the muscularis mucosae layer in 2 cases,submucosal layer in 5 cases,and muscularis propria layer in 2 cases;all 9 patients successfully underwent ESD guided exploration to locate the embedded fish bones in the mucosa and take out,with a median operation time of 22.33 minutes(range 9-45 minutes).Intraoperatively,the distance of the foreign bodies(fish bones)from the incisors was 16-22 cm in the upper segment(8/9)and 38 cm in the lower segment(1/9);regarding the depth of embedding,2 cases were within the mucosal layer(2/9),5 cases within the submucosal layer(5/9),and 2 cases within the muscularis propria layer(2/9),with one case extending to outside the oesophageal cavity(1/9).Before and during the operation,2 cases were diagnosed with local small perforations(2/9),and 2 cases had significant bleeding at the local wound site during the procedure(2/9);the postoperative hospital stay was 3.67 days(range 2-7 days);the follow-up period postoperatively ranged from 41.39 to 86

关 键 词：超声内镜 内镜黏膜下剥离术 食管鱼刺异物 

分 类 号：R655.4[医药卫生—外科学]