超声胃镜辅助内镜下诊治上消化道黏膜下肿物的探讨

目的]探讨上消化道黏膜下肿物的内镜下诊断及治疗方法选择。方法]对内镜下发现的黏膜下肿物进行超声胃镜或内镜下超声微探头检查,根据其回声强弱、肿物大小、浸润管壁的层次、边界情况,结合胃镜检查的镜下表现进行诊断并做出治疗方法的选择。结果]超声检查的黏膜下肿物共78例,其中黏膜下平滑肌瘤和〈2 cm的良性间质瘤共56例,行内镜下橡皮圈结扎术49例,成功率为100%,未发生出血、穿孔等并发症;黏膜下囊肿和黏膜下脂肪瘤6例,行内镜下高频电切术,无并发症发生;较大的间质瘤和恶性间质瘤13例,建议手术治疗,术后病理组织检查11例与胃镜检查符合,1例为胃手术后肉芽组织增生表现,另外1例为克隆氏病;异位胰腺3例。结论]超声内镜可以协助诊断消化道黏膜下肿物的性质;内镜下橡皮圈结扎法是治疗直径〈2 cm的黏膜下肿物安全有效的手段。

Endoscopic diagnosis and therapy assisted by EUS of upper gastro-intestinal submucosal tumors

Objective] To research and discuss the method in diagnosis and therapy of upper gastro-intestinal submucosal tumors using both endoscope an Endoscopic ultrasonography.Methods] Choose patients presumed submucosal tumor by endoscope,then use ultrasonography endoscope to make a further result,and choose varies treatment methods for them.Results] Totally,there were 78 cases of submucosal tumor,smooth muscle tumor and benign stromal tumor(within 2 cm) 56 cases,49 patients accepted the rubber band ligation treatment,all succeeded without bleeding or perforation appears.13 Bigger benign stromal tumors and malignent stomal tumor,we recommended them to accept surgical treatment,after surgery,11case's diagnosis were the same as endoscopic,the other 2 were 1 Crohn's disease and 1 granulation tissue after surgery.Conclusion] Endoscopic ultrasonography is valuable in diagnose the submucosal tumor and helpful in choosing the effective treatment method;endoscopic band ligation is a effective and safety method in small submucosal tumor's therapy.