超声微探头在上消化道黏膜下隆起性病变中的诊断和指导治疗方式价值

目的探讨超声微探头在上消化道黏膜下隆起性病变中的诊断和治疗价值。方法对胃镜检查发现隆起性病变91例患者进行超声微探头检查,根据超声胃镜图像特点选择治疗方案;并对部分内镜治疗或手术切除病例进行超声微探头复查。结果发现外压性改变5例,黏膜下肿瘤86例,包括良性间质瘤50例,恶性间质瘤3例,浸润性癌5例,胃或食管癌手术后吻合口隆起8例,胃淋巴瘤1例,胃黏膜皱襞肥大2例,Brunner腺增生1例,脂肪瘤2例,异位胰腺2例,孤立性静脉瘤7例,静脉曲张4例,囊肿1例。28例黏膜肌层良性间质瘤和2例黏膜下层脂肪瘤采用胃镜下高频电凝切除,11例黏膜肌层间质瘤术后6个月超声微探头复查有3例在原切除部位见到残留的瘤体,胃或食管癌手术后吻合口隆起8例中4例复发并经病理学证实。结论超声微探头能显示黏膜下隆起病变的层次和性质,有利于治疗方案的选择和对治疗效果的评价,从而提高胃镜医师的诊断水平。

Value of Diagnosis and Treatment of Miniature Ultrasonic Probe on Submucosal Masses of Upper Gastrointestinal Tract

Objective To explore value of diagnosis and treatment of miniature ultrasonic probe(MUSP) on submucosal masses(SMMs) of upper gastrointestinal tract.Methods 91 patients with SMMs were diagnosed by gastroscopy and further examined with MUSP.Endoscopic therapy or surgical operation was taken according to the different layers of SMMs.The part of those patients with endoscopic therapy or surgical operation were re-examined by MUSP.Results 5 protuberances from extrinsic compression and 86 submucosal tumors were detected by MUSP,including 50 benign stromal tumors,3 mailgnant stromal tumors,5 infiltrative cancer,1 gastric lymphoma,2 hyperrugosity in stomac,1 brunner glangd hyperplasia,2 lipomas,2 etopic pancreas in stomach,7 isolated varix,4 varices,1 cyst .28 benign stromal tumors from mucosal muscularis and 2 gastric lipomas from submucosa,were resected by endoscopy.After 6 months of endoscopic therapy,tumor remnants were found in the primary resection points in 3 of 11 patients;tumor relapse were detected in anastomoseing scoop in 4 of 8 patients with gastric or oesophageal cancer after 6 months of surgery,confirmed further by pathology.Conclusion MUSP can distinguish clearly different layers of SMMs in upper gastrointestinal tract,leading to definite diagnosis of SMMs,helping to select treating methods of SMMs and evaluate the therapeutic effects on SMMs.This helps gastroscopists to improve their diagnosis.