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。

MPS in diagnosing and treating gastrointestinal submucosal protrusive lesions

Objective To evaluate the value of miniprobe sonography (MPS) in diagnosing gastrointestinal submucosal protrusive lesions and selecting the indicated manual for treatment. Methods According to the sizes, properties, and depth of SMTs in the gastrointestinal tract detected by the MPS, different methods of resection were performed. Results Of 24 cases, 11 SMTs lying in submucosa under 2cm in diameter (2 benign gastrointestinal stromal tumors, 3 lipomas, 5 cysts, 1 granular cell tumor) were attempted with EMR or argon plasma coagulation (APC) ; there were no complications of hemorrhage or perforation. Thirteen SMTs lying in muscularis propria or with size of SMTs above 2 cm in diameter (4 malignant GISTs, 6 benign GISTs, 1 lipoma, 2 aberrant pancreas) were performed by surgical resection. Preoperative diagnoses of SMTs by MPS were consentient with their histological diagnoses. Conclusion MPS may detect the size, property, and depth of SMTs in the gastrointestinal tract and is helpful in selecting indicated cases for endoscopic resection. Endoscopic therapy of SMTs lying in mucosa or submucosa under 2cm in diameter is a safe and effective procedure.