超声内镜联合 EMR 或 ESD 在食管表浅隆起性病变诊断和治疗中的作用

摘要

Objective To investigate the use of endoscopic ultrasound ( EUS) in combination with endoscop-ic mucosal resection(EMR)/endoscopic submucosal dissection (ESD) for the diagnosis and treatment of esophageal superficial elevated-type lesions to improve the diagnosis of esophageal superficial elevated-type lesions.Methods Thirty-five patients with esophageal superficial elevated-type lesions diagnosed by endoscopic ultrasonography received EMR/ESD in our hospital from September 2009 to August 2012 .The EUS and clinicopathologic data for 35 patients with esophageal superficial elevated-type lesions were retrospectively analyzed .All 35 patients were followed up .Re-sults Of 35 patients included , 21 underwent EMR and 14 underwent ESD .The pathologic type: early esophageal cancer , 9 cases;severe dysplasia , 5 cases;benign stromal tumor , 3 cases;adenomatous polyp , 4 cases;non-adeno-matous polyp, 6 cases;leiomyoma, 8 cases.Endoscopic ultrasound and pathological examination showed the lesion source level of 35 cases were all located at mucosa , muscularis mucosa and submucosa .Conclusion Endoscopic ul-trasound in combination with EMR or ESD can improve the diagnosis of esophageal superficial elevated -type lesions . EMR and ESD are minimally invasive , effective, safe, fast for treating of early esophageal elevated-type lesions.%目的：探讨超声内镜（EUS）联合内镜下黏膜切除术（EMR）或内镜下黏膜剥离术（ESD）在食管表浅隆起性病变诊断和治疗中的价值。方法对35例经EUS检查拟诊为食管表浅隆起性病变患者进行EMR或ESD治疗的病例资料进行回顾性研究，分析病变部位的EUS图像、病理诊断结果及随访治疗效果。结果35例中21例经EMR治疗，14例经ESD治疗。经病理组织学检查确诊为早期食管癌9例，重度不典型增生5例，良性间质瘤3例，腺瘤性息肉4例，非腺瘤性息肉6例，平滑肌瘤8例。经EUS及病理证实病变均起源于黏膜层、黏膜肌层和黏膜下层。34例分别于术后1、3、6月复查EUS随访，术后1个月后伤口均完全愈合，无出血、食管狭窄及局部复发现象发生。结论联合应用EUS和EMR或ESD技术，不仅可以提高食管表浅隆起性病变早期的确诊率，而且是一种微创、有效、安全、快速的治疗措施。