内镜超声检查在上消化道黏膜下肿瘤微创治疗中的价值研究

目的评价超声内镜检查对上消化道黏膜下肿瘤的诊断价值及指导内镜下微创治疗黏膜下肿瘤的疗效及安全性。方法经超声内镜诊断上消化道黏膜下肿瘤82例，根据黏膜下肿瘤的起源层次、大小及性质分别选择不同的内镜治疗方案，内镜治疗包括高频电凝电切术、内镜下黏膜切除术、皮圈套扎术等。标本行常规病理学及免疫组化检查。术后定期内镜随访。结果26例超声判断起源于黏膜肌层的上消化道黏膜下肿瘤行高频电凝电切术；17例起源于黏膜肌层的平坦型上消化道黏膜下肿瘤行内镜下黏膜切除术；38例起源于固有肌层和1例起源于黏膜肌层的上消化道黏膜下肿瘤行皮圈套扎术。内镜超声诊断与术后病理符合率为91．4％。术后1例出血，其余无严重并发症发生。79例术后随访3—24个月无复发。结论超声内镜能够对消化道黏膜下肿瘤进行起源和定性诊断，超声内镜为内镜微创治疗选择消化道黏膜下肿瘤适应证具有良好的指导作用，内镜治疗是消化道黏膜下肿瘤治疗的安全、有效的手段。

Value of endoscopic ultrasonography in choice of endoscopic therapy strategies for submucosal tumors in upper gastrointestinal tract

Objective To evaluate the diagnostic value of endoscopic ultrasonography (EUS) for submucosal tumors in upper gastrointestinal tract, and its influence on choice of endoscopic therapies. Methods A total of 82 submucosal tumors from upper gastrointestinal tract were examined by EUS, and treated by various endoscopic therapeutic techniques including fulguration with high frequency current ( FHFC), endoscopic mucosal resection (EMR) and endoscopic band ligation according to orion, size and property of the lesion. The diagnoses of 58 reseeted samples were determined by routine pathological examination and immunohistochemistry. All patients were followed up with routine endoscopy and EUS. Results FHFC was applied in 26 lesions originated from muscularis mucosa, EMR was used in 17 flat lesions originated from muscularis mucosa, and endoscopic band ligation in 38 lesions from muscularis propria and 1 tumor from muscularis mucosa. The diagnostic accuracy of EUS was 91.4% (53/58). Except for post-operative bleeding in 1 patient, no other complications were observed. A total of 79 cases were followed up for 3-24 months, and no recurrence was found. Conclusion EUS can display the origin and property of submucosal tumors in upper gastrointestinal tract and guide the selection of endoscopic therapy, which is effective and safe in treatment of submucosal tumor in upper gastrointestinal tract.