目的：探讨超声内镜辅助下橡皮圈套扎治疗上消化道黏膜下肿瘤(submucosal tumor,SMT)的适应证、疗效及并发症等。方法选取近年来经超声内镜确诊患有上消化道黏膜下肿瘤的患者69例共71枚病变,所有患者均于超声内镜评估后行橡皮圈套扎治疗,术后常规给予质子泵抑制剂治疗,并于2~4周后复查胃镜。结果肿瘤直径0.5~1.5 cm,病变位于食管32枚(45.1%),胃23枚(32.4%),十二指肠16枚(22.5%)；位于黏膜深层28枚(39.4%),黏膜下层20枚(28.2%),固有肌层23枚(32.4%)；病变形态广基56枚(78.9%),亚蒂15枚(21.1%)；一次性套扎成功63枚(88.7%),失败8枚(11.3%),对治疗成功与失败组病变进行进一步分析显示,肿瘤大小、起源层次及质地是决定此方法是否成功的关键因素。结论对上消化道黏膜下肿瘤进行超声内镜检查,能够获取病变起源、大小以及弹性等信息,是临床开展橡皮圈套扎治疗的重要术前诊断方法。%Objective To evaluate the indications,safety and efficiency of elastic band ligation on upper gastrointestinal submucosal tumor(SMT)guided by endoscopic ultrasonography (EUS).Methods The study enrolled 69 patients with a total of 71 lesions,which were diagnosed as upper gastrointestinal SMT by EUS.The endoscopic elastic band ligation was performed on each of the patients.Then,all patients received proton pump inhibitor treatment for two weeks and they were followed up with endoscopy after 2-4 weeks.Results Of 69 patients,the diameters of lesions ranged 0.5-1.5 cm,32 cases(45.1%)located in esophagus,23 cases(32.4%)in stomach,1 6 cases(22.5%)in duodenal;28 cases (39.4%)in deep mucosal,20 cases (28.2%)in submucosal,23 cases (32.4%)in muscularis propria,56 cases(78.9%)with wide base,1 5 cases(21.1%)with rebagliati,respectively;63 cases(88.7%)of them were sloughed successfully.Statistics showed that the decisive factors for successful treatment were the size,layer of invasion and elasticity.All patients had no bleeding,perforation,severe guidance dysphagia or other complications. Conclusion EUS is important for endoscopic elastic band ligation of upper gastrointestinal SMT.The tumor size, layer of invasion and elasticity can be evaluated by EUS precisely.
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