环扫超声内镜术前评估对食管上皮下肿物内镜治疗的意义

目的探讨环扫超声内镜(EUS)术前评估对食管上皮下肿物内镜治疗的意义。方法选取内镜发现食管上皮下肿物并行内镜下或外科手术治疗的患者30例,麻醉状态下行环扫EUS术前评估。食管上皮下肿物内镜下治疗可选择不同内镜下手术方式,黏膜肌层病变非气管插管麻醉行内镜下黏膜切除术(endoscopic mucosal resection,EMR);黏膜下层、固有肌层病变气管插管麻醉行内镜黏膜下隧道肿瘤切除术(submucosal tunneling endoscopic resection,STER)或外科手术。结果20例术后诊断为黏膜肌层病变中,19例术前环扫EUS明确诊断,1例术前诊断为固有肌层病变;8例术后诊断为固有肌层病变及2例黏膜下层病变中,术前环扫EUS均明确诊断。Weighted Kappa评价显示,点估计0.92268,95%CI估计0.77431~1.00000,提示环扫EUS诊断与术后内镜下诊断一致性优秀。结论环扫EUS对食管上皮下肿物层次定位有较高的可靠性,对手术方式及麻醉方式的选择有指导意义。检查可在患者麻醉状态下完成,检查过程较舒适。

The significance of preoperative evaluation of radial EUS in endoscopic therapy of esophageal subepithelial masses

Objective To investigate the significance of preoperative evaluation of radial endoscopic ultrasonography(EUS)in endoscopic therapy of esophageal subepithelial masses.Methods 30 patients with esophageal subepithelial masses found by endoscopy under anesthesia and treated by endoscopy or surgery were selected for preoperative evaluation with radial EUS.Endoscopic therapy could be performed by different endoscopic methods.Endoscopic mucosal resection(EMR)for mucosal muscularis lesions could be performed by non-endotracheal intubation anesthesia.Submucosal tunneling endoscopic resection(STER)for muscularis propria lesions should be performed by endotracheal intubation anesthesia.Results In 20 patients of postoperative diagnosed as mucosal muscularis lesions,19 patients of preoperative clearly diagnosed by radial EUS,and 1 patient of preoperative clearly diagnosed as muscularis propria lesion.8 patients diagnosed as muscularis propria lesions and 2 patients diagnosed as submucosal lesions of preoperative were clearly diagnosed by radial EUS.Weighted Kappa evaluation showed that the point estimate was 0.92268,95%CI estimate was 0.77431-1.00000,suggesting that the consistency between radial EUS and postoperative diagnosis was excellent.Conclusion Radial EUS has a high reliability in the localization of esophageal subepithelial masses,and has guiding significance for the selection of endoscopic methods and anesthesia methods.The examination can be performed under anesthesia and the procedure is comfortable.