微探头超声指导内镜黏膜下剥离术治疗上消化道黏膜下隆起性病变的价值

背景：微探头超声（MPS）能对上消化道黏膜下隆起性病变进行较准确的定位，并初步定性诊断，内镜黏膜下剥离术（ESD）可完整切除病变，目前MPS指导ESD治疗上消化道黏膜下隆起性病变的研究少见。目的：评价MPS指导ESD治疗上消化道黏膜下隆起性病变的价值。方法：对胃镜检查发现的89例上消化道黏膜下隆起性病变行MPS检查，比较两者的诊断准确率。然后采用ESD切除病变，分析手术情况。结果：上消化道黏膜下隆起性病变以平滑肌瘤和间质瘤为主，MPS对上消化道黏膜下隆起性病变的总体诊断准确率显著高于胃镜（83．1％对51．7％，P〈0．05）。82例病变位于黏膜肌层或黏膜下层，平均直径为12．6mm，平均手术时间28．2min，ESD完整切除率100％；5例病变位于固有肌层，平均直径为13．8mm，平均手术时间48．5min，ESD完整切除率71．4％，其余2例固有肌层病变因难以控制的出血和黏连而行外科手术。所有患者术后随访无病变残留和复发。结论：MPS可对上消化道黏膜下隆起性病变作出较准确的判断，应作为内镜下治疗的术前常规检查。MPS引导ESD治疗上消化道黏膜下隆起性病变安全、有效。

Value of Miniprobe Uitrasonography-guided Endoscopic Submucosal Dissection for Treatment of Upper Gastrointestinal Submucosal Protuberant Lesions

Background： Miniprobe ultrasonography （MPS） is capable of locating and diagnosing upper gastrointestinal submucosal protuberant lesions, and endoscopic submucosal dissection （ESD） can completely resect the lesions. However, studies on MPS-guided ESD for the treatment of upper gastrointestinal submucosal protuberant lesions are rare. Aims： To evaluate the value of MPS-guided ESD for the treatment of upper gastrointestinal submucosal protuberant lesions. Methods ： Eighty-nine patients with upper gastrointestinal submucosal protuberant lesions detected by endoscopy had MPS performed. Accuracy of endoscopy and MPS for diagnosis of upper gastrointestinal submucosal protuberant lesions was compared. Lesions were resected by ESD, and the main outcome was analyzed. Results： The accuracy of MPS for diagnosis of upper gastrointestinal submucosal protuberant lesions was significantly higher than that of endoscopy （83.1% vs. 51.7% , P 〈 0.05 ）. The lesion was originated from mucosal muscularis or submucous layer in 82 cases, with a mean diameter of 12.6 mm, and the mean operating time was 28.2 minutes, the en bloc resection rate was 100%. Seven lesions were originated from muscularis propria, of them 5 lesions had a mean diameter of 13.8 mm, and the mean operating time was 48.5 minutes, the en bloc resection rate was 71.4% ; another 2 cases were transferred to surgery because of intractable bleeding and adhesion. No lesion residue or recurrence was found during follow-up. Conclusions： MPS can accurately diagnose upper gastrointestinal submucosal protuberant lesions, and should be used as a routine examination before endoscopic treatment. MPS-guided ESD is an effective and safe procedure to resect submucosal protuberant lesions in upper gastrointestinal tract.