高频超声小探头引导内镜下切除消化道表浅隆起性病变

目的 探讨经内镜高频超声小探头引导内镜下黏膜切除术治疗消化道表浅隆起性病变的安全性、可行性.方法 对普通内镜下发现的67例消化道表浅隆起性病变,经内镜活检钳道插入高频超声小探头进行检查,对其中39例显示病变来源于黏膜层、黏膜肌层及黏膜下层的病变行内镜下黏膜切除术.切除的病变送病理检查.结果 16例消化道息肉、2例异位胰腺、14例间质瘤、3例脂肪瘤,3例类癌,1例早期胃癌共39例病变内镜下完全切除.操作过程顺利,其中一例出现术后迟发性出血,给予内镜下成功止血,无其他严重并发症出现,病理符合率87.1%.结论 高频超声小探头检查可初步明确病变来源及层次,安全有效地指导消化道表浅隆起性病变黏膜切除术治疗.     

超声内镜检查在消化道隆起性病变应用中的临床价值

目的 评价超声内镜检查在消化道隆起性病变应用中的临床价值.方法 用超声内镜及超声小探头检查126例消化道隆起性病变患者,其中105例行无痛超声内镜检查.结果 息肉13例,癌4例,囊肿13例,血管瘤2例,异位胰腺2例,炎性隆起3例,胃黏膜异位2例,黏膜下肿瘤61例,壁外压迫14例,未见异常11例,均明确了病变起源层次.对部分病例进行内镜下或外科手术治疗,术后病理诊断与超声内镜诊断符合率92%.结论 应用超声内镜检查可以明确上、下消化道隆起性病变的起源(定位)和初步诊断,对隆起性病变的治疗方案具有指导意义.     

超声内镜在上消化道隆起性病变诊断和治疗中的应用

目的探讨超声内镜对上消化道隆起性病变的诊断价值及指导内镜下微创治疗的临床效果。方法对56例普通内镜下诊断为上消化道隆起性病变的患者进行超声内镜检查,根据病变的起源层次及性质决定治疗方案,其中23例分别行内镜下高频电切除、黏膜切除术或鼠齿钳钳夹治疗,4例行外科治疗。结果 56例上消化道隆起性病变中,按隆起部位分为食管15例（26.79%）,胃34例（60.71%）,十二指肠7例（12.50%）。按病变类型分为平滑肌瘤11例,间质瘤8例,息肉7例,异位胰腺6例,囊肿6例,脂肪瘤2例,静脉曲张3例,外压10例,未发现病变3例。内镜下治疗仅黏膜切除术中少量渗血,用氩气或者钛夹即可止血,无其他并发症出现。对27例患者进行内镜下或外科手术治疗,术后病理诊断与超声内镜诊断符合率92.0%。结论超声内镜可显示消化道管壁的层次结构和壁外情况,有利于上消化道隆起性病变的诊断和鉴别诊断;为内镜微创治疗选择隆起性病变适应证提供良好的指导作用,部分病变内镜下可安全有效地切除。     

内镜下超声微探头在诊治消化道黏膜下隆起病变的作用

目的探讨超声微探头（MPS）对消化道黏膜下隆起病变的诊断正确率和MPS提供的诊断资料对内镜医师选择治疗方式的参考价值。方法对消化道黏膜下隆起病变进行内镜下超声微探头检查，根据隆起的大小、件质和存管壁的层次等超声资料来诊断黏膜下隆起病变并选择切除方法。结果在24例患者中，对MPS诊断位于黏膜下层以上的直径小于2cm的消化道黏膜下肿块11例（良性问质瘤2例，脂肪瘤3例，囊肿5例，食管颗粒细胞瘤1例）采用内镜下治疗（黏膜切除术、氩离子体凝固治疗），无出血、穿孔并发症对于MPS诊断直径2cm以上或位于固有肌层以下的消化道黏膜下肿块13例（恶性胃肠道间质瘤4例，良性胃肠道问质瘤6例，脂肪瘤1例，异位胰腺2例）行外科手术。其超声诊断与病理诊断结果相一致。结论MPS可诊断黏膜下隆起的大小、层次和性质，有助于选择适应内镜下治疗的黏膜下隆起病例，内镜下治疗位于黏膜下层以内直径小于2cm的消化道黏膜下肿块SMT是安全、有效的方法。     

微探头内镜超声检查在胃窦小隆起病变诊断中的应用价值

[目的]评价微探头内镜超声在胃窦小隆起病变诊断中的应用价值。[方法]回顾性总结分析行微探头内镜超声检查的42例胃窦小隆起病变患者的临床资料,以内镜下黏膜切除术或黏膜下剥离术或手术切除标本病理诊断为最终结果,分析比较微探头内镜超声及内镜下活检对胃窦小隆起病变的诊断符合率。[结果]微探头内镜超声检查在胃窦小隆起病变的诊断符合率为83.3%(35/42),内镜下经活检钳行病理检查对胃窦小隆起病变的诊断符合率为45.2%(19/42),超声内镜的诊断符合率高于胃镜活检,差异有统计学意义(P0.01)。[结论]内镜下活检不能作为诊断胃窦小隆起病变的诊断依据;微探头内镜超声在胃窦小隆起病变有较高的临床诊断价值,对黏膜下病变的治疗方案的选择具有指导意义。     

超声胃镜在上消化道黏膜下肿物诊断及治疗中的指导意义

<正>黏膜下肿物(SMT)是内镜检查中所见的常见疾病,虽然其性质、来源不同,但内镜下均为表面光滑的隆起性病变,常规内镜无法确定肿物的来源和性质。目前,超声胃镜是诊断SMT的首选方法,尤其对于<0.5 cm的肿瘤,超声内镜能够清晰显示消化道管壁的层次,显示消化道毗邻脏器和组织的情况,明确隆起性病变的起源层次,并根据其起源层次及回声特点,初步明确病变性质,鉴别病变来源〔1〕。本文主要探讨超声胃镜在     

超声内镜对上消化道隆起病变诊断价值的临床研究

目的探讨内镜超声不同频率探头对上消化道隆起病变的诊断价值。方法应用不同频率超声探头对180例食管、胃、十二指肠黏膜及黏膜下隆起性病变进行超声检查,总结内镜超声特点,并与最终EMR、ESD或外科手术得出的病理诊断相比较。结果发现慢性炎症71例,上消化道早癌10例,表现为黏膜层等回声或稍低回声改变,病变均未突破黏膜下层。间质瘤或平滑肌瘤46例,多位于食管或胃,表现为黏膜肌层及以下各层次的均匀或不均匀低回声为主,外覆强回声包膜,两者在超声下很难区别。脂肪瘤10例,多位于胃体及胃窦,表现为黏膜下层边界清楚的强回声。囊肿14例,多位于十二指肠,表现为位于黏膜下层的单房或多房性的无回声区,包膜完整。恶性淋巴瘤1例,位于胃体,表现为局部黏膜肌层及黏膜下层增厚,呈中低回声,不均匀,较少侵及固有肌层。血管性病变(血管瘤、静脉曲张)12例,多位于食管及胃底,表现为黏膜及黏膜下层的无回声,部分中高回声,圆形或不规则形,散在或成簇状分布,部分互相沟通。另外还有食管结核2例,异位胰腺6例,壁外压迫10例。超声与最终诊断结果均相符。结论内镜不同频率探头超声检查可以明确上消化道黏膜及黏膜下隆起病变的大小,消化管壁起源和边界,根据超声特征对黏膜及黏膜下病变的良恶性判断有一定的价值,同时能与腔外压迫性病变相鉴别。     

小探头内镜超声诊断上消化道隆起病变643例分析

目的探讨小探头内镜超声检查（mEUS）对卜消化道隆起病变的诊断价值。方法对626例患者的643个内镜提示上消化道降起病变行mEUS检盘，分析检查结果结果643个上消化道隆起性病变中，胃339个，食管218个，十二指肠69个，贲门17个。检出间质瘤和平滑肌（肉）瘤307个（位于黏膜肌层115个，黏膜下层8个和固有肌层184个），异位胰腺62个，脂肪瘤25个，囊肿39个，外压性病变89个，黏液腺瘤2个，血管瘤9个，息肉53个。142个病变取得病理诊断，其中126个与mEUS诊断符合。结论内镜超声检查能清楚渺示消化道肇的层次结构，对上消化道隆起病变具有准确的定位作用，并能提示病变的性质；但对间质瘤和平滑肌瘤的鉴别诊断及良恶性的判断有困难。     

小探头超声内镜对食管黏膜隆起性病变的诊断价值

对98例食管隆起性病变患者进行小探头超声内镜（MPS）检查。结果MPS诊断为间质细胞瘤40例、恶性间质细胞瘤5例、脂肪瘤6例、血管瘤3例、食管囊肿6例、息肉15例、食管静脉曲张11例、食管腔外压迫12例。其中38例在MPS检查后于内镜下切除病变。48例有手术或活检病理检查结果,其诊断与MPS诊断完全相符。MPS对食管黏膜隆起性病变具有较好的定位及定性诊断价值。     

113例消化道隆起病变内镜黏膜下剥离术诊治临床资料分析

[目的]探讨消化道黏膜下隆起病变超声内镜的诊断价值及内镜黏膜下剥离术(ESD)疗效。[方法]选择普通胃肠镜检查发现的消化道黏膜局限性隆起病变患者113例,并行超声胃镜检查进一步确诊,以术后病理检查结果作为金标准。定期随访追踪术后1、3、6、12个月,复查胃镜观察术后创面愈合及复发情况。[结果]113例消化道黏膜下隆起性病变中年龄主要分布在40～60岁,贲门隆起7例(6.19%),胃窦14例(12.38%),胃底29例(25.66%),胃体28例(24.77%),食管19例(16.81%),直肠及结肠14例(12.38%),胃角1例(0.88%),十二指肠降部1例(0.88%)。病理结果与超声内镜检查结果相比较,超声内镜诊断结果与病理结果比较差异无统计学意义(P0.05),2种方法诊断隆起病变吻合度有统计学意义(吻合系数κ=0.676,P0.01)。[结论]超声内镜对消化道黏膜下隆起病变诊断准确率高,ESD治疗消化道黏膜下隆起病变安全、有效。     

微型探头内镜超声对上消化道黏膜下肿物的诊断价值

目的研究微型探头内镜超声检查对上消化道黏膜下肿物的诊断价值。方法采用微型探头内镜超声观察2003-02~2004-06天津医科大学总医院消化科诊治的91例上消化道黏膜下肿物,明确其来源的层次、病变位置,并分析结果。结果上消化道黏膜下肿物以平滑肌瘤最为多见,共57例,病变部位以食管最多;其它依次是囊肿14例、血管病变9例、脂肪瘤5例、异位胰腺4例和恶性间质瘤2例。恶性病变及部分良性病变获组织学证实。结论微型探头内镜超声对上消化道黏膜下肿物具有准确的定位作用,能较好地提示病变性质,是诊断上消化道黏膜下肿物的一种简便、安全、有效的方法。     

微型探头超声内镜对上消化道黏膜下肿瘤的诊治价值

目的探讨微型探头超声内镜（InEus）在上消化道黏膜下肿瘤的诊断和治疗中的作用。方法对30例疑为上消化道黏膜下肿瘤的患者进行微型探头超声内镜检查,根据黏膜下肿瘤的起源层次．部分患者接受内镜下治疗或外科手术。结果mEUS检查的30例患者中,发现消化道壁外压迫1例（主动脉弓1例）;黏膜下肿瘤29例,包括平滑肌瘤12例,良性间质瘤4例,恶性间质瘤1例,脂肪瘤4例,静脉瘤3例,异位胰腺1例,囊肿4例。12例起源于黏膜肌层的肿瘤行高频电切除术切除,3例静脉瘤行尼龙圈套结扎,4例脂肪瘤及4例囊肿行高频电切除。结论mEUS检查能清楚显示上消化道黏膜下肿瘤的大小．起源层次、生长方向及邻近组织结构关系,较准确地判断肿瘤的性质。进而指导黏膜下肿瘤治疗方案的选择。     

Clinical Evaluation of Endoscopic Ultrasonogrphy in Diagnosis of Submucosal Tumor of the Upper Alimentray Tract

Abstract: The usefulness and the problems of endoscopic ultrasonograpy (EUS) in the diagnosis of submucosal tumors (SMT) of the upper alimentary tract were evaluated in this study. EUS was carried out in 86 cases with SMT of the stomach. Tumors of 13 cases was confirmed histologically (leiomyoma in 7 cases, leiomyosarcoma in one, lipoma in 2, gastric cyst in one, aberrant pancreas in one and Schwannoma in one case). In only one out of 22 cases with SMT of the esophagus, the tumor was surgically resected and a pathological examination revealed leiomyoma EUS was useful in estimating the histological origin of SMT by observation of the relationship between the location of the tumor and each layer in the gastric or esophageal wall. However, it was imposible to differentiate leiomyoma from leiomyosarcoma in myogenic tumors through the echoic pattern of the tumor by EUS alone at the present time. EUS was also useful in distinguishing the cause of extragastric compression showing similar findings with SMT, which could not be clarified by X-ray or endoscopic examination. In fact, organs compressing the stomach were easily clarified by EUS. It was decided that EUS should be performed in all cases whenever there is any doubt of SMT existing after an X-ray or endoscopic examination.     

The diagnosis of submucosal tumors of the stomach by endoscopic ultrasonography

The clinical value of endoscopic ultrasonography (EUS) in the diagnosis of submucosal tumors (SMTs) of the stomach was examined. We used echo endoscopes with a 7.5 or 10.0 MHz radial-scan transducer made by Olympus Co. Ltd. EUS was carried out on 80 patients with SMTs of the stomach including 54 cases confirmed histologically (24 cases of leiomyoma, 3 of leiomyosarcoma, 12 of cysts, 7 of aberrant pancreas, 4 of lipoma, 2 of carcinoid, and 3 of other diseases). Fifty-nine patients with extraluminal compression were detected by endoscopy and/or x-ray examination. We examined the effectiveness of EUS based on our analysis of the gastrointestinal tract wall seen in the EUS image as a five-layered structure corresponding with that of the histological layers. As a result, SMTs and extragastric compression were easily distinguishable in the EUS images of the lesions. The size, location, and origin of the SMTs could be detected. From the location of the SMT in the five-layered structure seen in the EUS image we could predict its histological nature. Thus, EUS was a most valuable method not only in the diagnosis of intramural and extramural SMTs but also in the detection of extragastric compressive lesions and organs.     

经内镜切除消化道黏膜下肿瘤

目的 探讨内镜切除消化道黏膜下肿瘤(SMT)的疗效、安全性以及切除前内镜超声检查(EUS)的价值。方法 SMT71例中食管36例，胃29例，十二指肠和直肠各3例，64例(90．1％)治疗前行EUS检查。SMT大小6～20mm，平均14．2mm。55例用双活检管道内镜行黏膜切除术(EMR)，把持钳剥离SMT后，将其切除；6例先用圈套器在SMT基底部勒紧，再注入生理盐水，切除SMT；10例≤10mm的用透明帽吸引法切除。结果 71例SMT中68例(95．8％)内镜下完全切除；2例(1例异位胰腺、1例胃平滑肌瘤)病变残留(4周时胃镜发现)；l例直肠平滑肌瘤，未能切除改行外科手术。67例平均随访18．7个月未见复发。组织学诊断平滑肌瘤51例(71．8％)，颗粒细胞瘤、纤维瘤、异位胰腺、脂肪瘤、间质瘤和类癌共15例(21．1％)，5例(7．0％)间叶肿瘤未做免疫染色，不能确定组织来源。并发症：9例局部少量出血，1例胃间质瘤切除后胃穿孔。结论 内镜切除SMT是一种较安全、有效的方法，并可获得组织学诊断，EUS对内镜治疔SMT选择适应证有重要的价值。     

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。     

ENDOSCOPIC SUBMUCOSAL DISSECTION FOR GASTRIC SUBMUCOSAL TUMOR,ENDOSCOPIC SUB‐TUMORAL DISSECTION

Gastric submucosal tumor (SMT) is frequently found during screening endoscopy, but definitive diagnosis based on histological confirmation is relatively difficult. Even without accurate diagnosis before treatment, open or laparoscopic surgery is currently carried out to remove SMT. The purpose of this study was to demonstrate the feasibility of endoscopic submucosal dissection (ESD) in diagnostic treatment for submucosal tumor (SMT) of the stomach. Subjects in this case study comprised nine patients who had undergone ESD for gastric SMT. Before treatment, endoscopic ultrasonography was carried out in all cases to evaluate depth and origin of the SMT. Then ESD was only indicated for tumors of submucosal layer or muscularis mucosa origin. Using an endoscopic sub‐tumoral dissection technique with a hook knife and a flex knife, local complete resections were achieved in all patients without severe complications. These results suggest the clinical benefits of ESD avoiding oversurgery for the diagnostic treatment of gastric SMT of the submucosal layer and muscularis mucosa origin.     

消化道黏膜下肿物的内镜及超声内镜下特点分析

目的探讨消化道黏膜下肿物的内镜及超声内镜下特点。方法对153例消化道黏膜下肿物进行内镜及超声内镜检查,最终经病理学及免疫组化明确诊断。结果确诊消化道平滑肌瘤51例、胃肠道间质瘤37例、脂肪瘤30例、类癌21例、异位胰腺7例、神经鞘瘤3例、错构瘤3例和血管球瘤1例。超声内镜对平滑肌瘤、间质瘤、脂肪瘤、类癌、异位胰腺、神经鞘瘤、错构瘤和血管球瘤的诊断符合率分别为92%、92%、100%、71%、71%、0、0和100%,其总诊断符合率为86%,明显高于内镜总诊断符合率(70%)。结论超声内镜可明确消化道黏膜下肿物的大小、起源、回声、生长方式,对消化道黏膜下肿物的诊断及鉴别诊断有重要作用。     

Gastric calcifying fibrous tumor removed by endoscopic submucosal dissection

The World Health Organization describes calcifying fibrous tumors(CFTs) as rare, benign lesions characterized by hypocellular, densely hyalinized collagenization with lymphoplasmacytic infiltration. These tumors rarely involve the gastrointestinal(GI) tract. A routine endoscopic upper gastrointestinal screen detected a 10-mm submucosal tumor(SMT) in the lesser curvature of the lower corpus of the stomach of an apparently healthy, 37-year-old woman with no history of Helicobacter pylori infection. Endoscopic ultrasonography(EUS) localized the internally isoechoic, homogeneous SMT mainly within the submucosa. Malignancy was ruled out using endoscopic submucosal dissection(ESD). A pathological examination confirmed complete resection of the SMT, and defined a hypocellular, spindle-cell tumor with a densely hyalinized, collagenous matrix, scattered lymphoplasmacytic aggregates as well as a few psammomatous, dystrophic calcified foci. The mass was immunohistochemically positive for vimentin and negative for CD117(c-kit protein), CD34, desmin, smooth muscle actin(SMA) and S100. Therefore, the histological findings were characteristic of a CFT. To date, CFT resection by ESD has not been described. This is the first case report of a gastric calcifying fibrous tumor being completely resected by ESD after endoscopic ultrasonography.