超声内镜在胃黏膜隆起性病变诊断及其内镜微创治疗中的应用价值

摘要

目的 探讨超声内镜(EUS)在胃黏膜隆起性病变诊断及其内镜微创治疗中的价值.方法 回顾分析均行EUS检查及内镜微创治疗的320例电子胃镜提示为胃黏膜隆起性病变患者的临床资料.以术后病理结果为金标准,比较EUS与电子胃镜的诊断符合率.观察患者手术类型及术中情况.术后3、6和12个月复查电子胃镜,观察创面愈合情况并了解局部是否复发.结果 胃黏膜隆起性病变在胃窦部多见,其次为胃底和胃体;最常见的病理类型依次为息肉、间质瘤及平滑肌瘤.EUS总体诊断符合率90.63%(290/320),高于电子胃镜的68.13%(218/320)(P<0.05).成功行内镜黏膜切除术和内镜黏膜下剥离术共141例,术中穿孔率、术中出血率、术后出血率分别为0.71%(1/141)、4.26%(6/141)、3.55%(5/141),术后局部复发率1.42%(2/141).术中转外科手术3例,其余患者采用高频电凝电切术或尼龙绳圈套器套扎术治疗,术后6个月创面完全愈合,无局部复发.结论 EUS对胃黏膜隆起性病变诊断准确率较高,对内镜微创治疗方法的选择具有较高的指导价值,内镜微创术术前联合EUS检查治疗大部分胃黏膜隆起性病变安全、有效.%Objective To explore the value of endoscopic ultrasonography(EUS) applied to diagnosis of gastric mucosal protrusion lesions and endoscopic minimally invasive treatment.Methods The clinical data of 320 patients diagnosed as gastric mucosal protrusion lesions by electronic gastroscope were retrospectively analyzed.All patients underwent EUS and endoscopic minimally invasive therapy.The postoperative pathological results were taken as golden standard,then the diagnostic accordance rate was compared between EUS and electronic gastroscope.The surgical approaches and intraoperative data of the patients were observed.Electronic gastroscopy was performed at postoperative 3,6 and 12 months to observe wound healing and local recrudescence.Results The gastric mucosal protrusion lesions were mainly located at gastric antrum,secondarily at gastricfundus and corpora ventriculi.The most common pathological types were polyp, stromal tumors and leiomyoma.The total diagnostic accordance rate of EUS was higher than that of electronic gastroscope[90.63%(290/320) vs 68.13%(218/320);P<0.05)].Endoscopic mucosal resection or endoscopic submucosal dissection was successfully conducted in 141 cases,and the rates of intraoperative perforation,intraoperative bleeding,postoperative bleeding and postoperative local recrudescence were 0.71%(1/141),4.26%(6/141),3.55%(5/141),and 1.42%(2/141)respectively. Conversion to open laparotomy occurred in 3 patients.The remaining patients underwent high-frequency electrocoagulation or ligation surgery with nylon endoloop,wound healing was observed in all cases at 6 months after operation,and no local recrudescence was found.Conclusion EUS achieves a higher diagnostic accuracy for gastric mucosal protrusion lesions and is valuable for the choice of endoscopic minimally invasive approaches. Endoscopic minimally invasive therapy combined with preoperative EUS is safe and effective for most cases of gastric mucosal protrusion lesions.