超声内镜及内镜微创治疗上消化道黏膜下肿瘤应用研究

摘要

目的探讨超声内镜对上消化道黏膜下肿瘤（SMT）的诊断价值及内镜微创手术切除SMT的疗效及安全性。方法对2013年10月至2014年12月该院胃镜检查发现的110例SMT患者进行超声内镜检查，根据检查结果选择不同治疗方案，其中行内镜下黏膜切除术（EMR）50例，内镜黏膜下剥离术（ESD）12例[其中内镜黏膜下挖除（ESE）术5例]，黏膜下隧道内镜切除术（STER）1例，外科手术切除19例，行针状刀开窗及热活检钳烧灼7例。手术标本均进行病理学及免疫组化检查，总结超声内镜特点，并与最终诊断进行比较。术后定期进行内镜随访1~24个月，观察内镜微创治疗的安全性和有效性。结果110例患者经内镜超声检查诊断为平滑肌瘤29例，间质瘤39例，脂肪瘤12例，异位胰腺19例，囊肿7例，神经内分泌瘤4例。89例切除标本经病理检查表明病灶完整切除，切缘及基底部无病变组织残留，其中黏膜肌层病变39例，黏膜下层病变28例，固有肌层肿瘤22例。超声内镜诊断与术后病理学诊断肿瘤性质符合率为84.27%（75/89），来源层次符合率为87.64%（78/89）。2例出血、3例穿孔患者均在镜下给予钛夹夹闭，经保守治疗后痊愈。86例患者内镜术后随访期间未见复发或远期并发症。结论超声内镜指导下微创切除SMT是一种安全、有效的微创治疗方法。%Objective To discuss ultrasonic endoscope′s diagnostic value in upper gastrointestinal tract submucosal tu-mor (SMT) and the curative effect and safety of using endoscope minimally invasive surgery to cut off submucosal tumor. Meth-ods Did ultrasonic endoscope on 110 SMT patients who did gastroscopy in this hospital from October ,2013 to December,2014. Different treatment were used in line with test results. 50 of them did endoscopic mucosal resection (EMR),12 of them did endo-scopic submucosal dissection(ESD)(5 ESE),1 of them did submucous tunnel endoscopic resection(STER),19 of them did sur-gical removal. Did pathology and immunohistochemical test on surgical samples. Summarized ultrasonic endoscope′s characteris-tics and made a comparison with ultimate diagnosis. Postoperative endoscope follow-up at regular intervals for 1-24 months was done to observe the safety and effectivity of endoscope minimally invasive surgery. Results 110 patients were diagnosed as li-omyoma(n=29),mesenchymoma(n=39),lipomyoma(n=12),heterotopic pancreas(n=19),cyst(n=7),neuroendocrine(n=4) by endoscope ultrasonic examination. 89 excision samples manifested complete focus excision by pathological examination. There was no lesion tissue residual in incisal edge and basilar part. There were 39 mucosal muscularis lesions ,28 submucosa lesions,22 muscularis propria tumors. The accordance rate of endoscope ultrasonic diagnosis and postoperative pathology diagnosis nature was 84.27%(75/89). The accordance rate of source level was 87.64%(78/89). 2 hemorrhage and 3 perforation patients were clipped under endoscope and cured using conservative treatment. 86 patients did not relapse or have long-term complications dur-ing postoperative follow-ups after endoscope surgery. Conclusions Using ultrasonic endoscope and endoscope minimally inva-sive surgery to cut off SMT is a safe and effective therapeutic method.