微探头超声结合ESD技术对消化道黏膜隆起性病变的诊疗价值

APPLICATION OF MINIPROBE ULTRASONOGRAPHY AND ENDOSCOPIC SUBMUCOSAL DISSECTION IN DIAGNOSIS AND THERAPY FOR SUBMUCOSAL PROTUBERANT LESIONS IN GASTROINTESTINAL TRACT

目的：评价内镜微探头超声（miniprobe ultrasonography,MPS）对消化道黏膜及黏膜下隆起性病变的诊断价值;探讨内镜下黏膜剥离术（endoscopic submucosal dissection,ESD）在治疗消化道黏膜隆起性病变中的价值。方法：对我院内镜中心2008-01~2009-08间普通胃肠镜检查发现的消化道黏膜局限性隆起病变,进行MPS检查,对位于黏膜下层以上的隆起性病变借助于ESD技术行内镜治疗。比较术前MPS诊断与内镜治疗术后病理结果的一致性;评价应用ESD技术治疗黏膜下层以上的隆起性病的可行性及疗效;1mo后复查胃肠镜及MPS。结果：MPS诊断消化道黏膜及黏膜下隆起性病变34例,其中食管21例,胃11例,大肠2例。诊断平滑肌瘤20例,间质瘤8例,脂肪瘤1例,纤维瘤1例,早期癌1例,中重度不典型增生3例。分别来源于黏膜层、黏膜肌层和黏膜下层。选择ESD治疗,均完整切除病变,成功率100%,术中穿孔1例,经保守治疗痊愈,未发生大出血及其他并发症,并发症发生率2.94%。ESD术后病理诊断与ESD术前MPS诊断符合31例,诊断准确率91.18%。1mo后复查内镜及MPS,原病变处溃疡愈合,瘢痕形成,病变切除完全。结论：MPS对消化道粘膜及黏膜下隆起性病变诊断准确率高,应用ESD技术对于消化道黏膜及黏膜下隆起性病变治疗彻底、安全、可靠、创伤小、费用低、并发症少,具有广泛的临床应用价值。MPS和ESD联合应用,可提高病变诊断准确性及治疗安全性。

Objective：To evaluate the diagnosis value of mucosal and submucosal protuberant lesions using miniprobe ultrasonography（MPS）.To investigate the clinical applied value of endoscopic submucosal dissection（ESD） to treat the mucosal and submucoscal protuberant lesions.Methods：Mucosal and submucosal protuberant lesions in gastrointestinal tract found by endoscopy in Jurnary 2008 to Augest 2009 were examined by MPS.The lesions which located in the above of submucosa were treated by ESD.After one month,all were followed by endoscopy and MPS.Results：Thirsty four patients with mucosal and submucosal protubernant lesions were diagnosed by MPS.Among them,twenty one lesions were located in the esophagus,eleven in the stomach,and two in the large intestine.Twenty leiomyomas,eight stromal tumors,one lipoma,one fibraoma,one early cancer,and three moderate and severe dysplasia were diagnosed,respectively.They rooted in mucosa,mina muscularis mucosae and submucosa,respectively.All the lesions were treated intact by ESD with one perforation,but cured by conservative treatment.No massive haemorrhage and other complications occurred.The rate of complication was 2.94 percentage.The pathological diagnosis of thirty one lesions after ESD was corresponded with the diagnosis by MPS before ESD.The rate of dignosis accurany of MPS was 91.98 percentage.Followed one month,the artificial ulcer of primary lesion healed,scar formed,and lesion excised intact.Conclusion：MPS has a high acurate rate in diagnosis of mucosal and submucosal protuberant lesions in gastrointestinal tract,and has an important clinical value to judge the nature of disease before ESD and after ESD.ESD is a complete,safe,and reliable method to treat the mucosal and submucosal protuberant lesions.It has also been superior of low hurt,low cost and low complication.So ESD has an extensive clinical application.MPS combines with ESD can increase the accurrate rate of diagnosis and security of treatment.