超声内镜辅助下ESD治疗上消化道隆起性病变的疗效及安全性探讨

Endoscopic ultrasonography—assisted endoscopic submucosal dissection for upper gastrointestinal protrusive lesions

目的探讨超声内镜对于应用ESD治疗上消化道隆起性病变的疗效及安全性。方法20例上消化道黏膜局限性隆起病变，先行超声内镜检查。再采用ESD进行治疗，比较术前超声内镜诊断与内镜治疗术后病理结果的一致性，记录手术耗时、整块切除率、并发症发生率及局部残留复发率。结果食管病变6例，其中早癌及高级别上皮内瘤变各1例，平滑肌瘤4例；胃内病变14例，其中胃早癌及高级别上皮内瘤变各3例，异位胰腺1例，间质瘤7例。术前EUS诊断与术后病理结果的一致性为100％。手术时间16～100（32．8±15．7）min；整块切除率85％．出血率为20％，穿孔率10％，术后随访1～12个月，无残留与复发。结论超声内镜对消化道黏膜隆起性病变诊断准确率高．超声内镜辅助下ESD治疗上消化道隆起性病变安全有效。

Objective To assess the efficacy and safety of endoscopic ultrasonography （EUS）-assisted endoscopic submucosal dissection （ESD） for upper gastrointestinal protrusive lesions. Methods Twenty upper gastrointestinal protrusive le- sions were detected by EUS, then resected by ESD. EUS image findings were compared with post-ESD pathological results. The mean operation time, rate of en bloc resection, incidence of complication and Iocar recurrence were documented. Results A- mong twenty lesions, 6 were located in the esophagus, 14 in the stomach. Four cases of early cancer, 4 cases of high grade in- traepithelial neoplasia, 1 case of heterotopic pancreas, 4 cases of leiomyomas and 7 cases of stromal tumor were diagnosed re- spectively. The pathological diagnosis of 20 lesions after ESD was all consistent with that by EUS before ESD. The operation time was 16-100min （mean 32.8 ± 15.7min）; the rate of en bloc resection was 85%, bleeding rate was 20.0%, perforation rate was 10.0% and no local recurrence was found. Conclusion EUS is highly accurate in diagnosis of protuberant lesions in gastroin- testinal tract. EUS-assisted ESD is a safe and effective therapeutic method for upper gastrointestinal protrusive lesions.