超声胃镜辅助内镜下诊治上消化道黏膜下肿物的探讨

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

关键词:  超声内镜  黏膜下肿物  结扎术

Key words:  submucosal tumor  endoscopic ultrasonography  rubber band ligation

摘要:

［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。

Abstract:

［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.