超声胃镜在上消化道隆起病变诊断与治疗中的价值

Value of Ultrasound Gastroscope in Diagnosis and Treatment of Protuberant Lesions in Upper Gastrointestinal Tract Lesions

目的探讨超声胃镜对上消化道隆起性病变的诊断与治疗价值。方法应用超声胃镜对118例上消化道隆起性病变患者进行检查及引导治疗。结果 118例上消化道隆起病变位于食管38例,其中食管平滑肌瘤23例、食管平滑肌肉瘤2例、食管息肉4例、食管囊肿2例、食管癌3例、食管孤立性静脉瘤1例、食管脂肪瘤1例、食管腔外压迫2例;位于胃80例,其中胃间质瘤26例、胃平滑肌瘤14例、胃脂肪瘤4例、胃底静脉瘤2例、异位胰腺4例、胃壁外压迫26例、未见异常4例,胃壁外压迫病变主要为脾脏(16/26,61.5%),其次是肝左叶、胆囊、胰腺囊肿、胰腺囊腺癌等。118例中行内镜下手术治疗45例,有3例(6.6%)发生创面边缘少量渗血,无一例发生大出血及穿孔等严重并发症;术后随访38例,创面均已愈合良好,无复发病例。术后病理确诊41例,超声胃镜与手术病理结果符合率为91.1%(41/45)。结论超声胃镜诊断上消化道黏膜下隆起性病变较为准确,能对病变的性质及起源做出诊断,并对治疗方法的选择提供参考。

Objective To investigate the value of ultrasound gastroscope in the diagnosis and treatment of protuberant lesions in upper gastrointestinal tract. Methods Ultrasound gastroscope examination was used to guide treatment in 118 patients with protuberant lesions in upper gastrointestinal tract. Results Among the 118 patients, protuberant lesions were located 38 and at stomach in 80. Among the 38 patients with esophageal lesions, esophageal found in 23, esophageal leiomyosarcoma in 2, cancer in 3, isolated esophageal varicosity compression in 2. Among the 80 patients with at esophagus in leiomyoma was esophageal polyp in 4, esophageal cyst in 2, esophagus in 1, esophageal lipomyoma in 1, and extraluminal gastric lesions, gastric stromal tumor was found in 26, gastric leiomyoma in 14, gastric lipomyoma in 4, fundus varicosity in 2, ectopic pancreas in 4, and extragastric compression in 26. No abnormalities were observed in 4 patients with esophageal lesions. Extraluminal compression was mainly caused by spleen （16/26, 61.5% ）, followed by left lobe liver, gallbladder, pancreas cyst, pancreatic cystadenocarcinoma, etc. Among the 45 patients who underwent endoscopic surgery, 3 patients had a small amount of bleeding at the wound edge. No patients had massive haemorrhage, perforation and other serious complications.Wounds healed well and no recurrences occurred in the 38 patients who underwent follow-up. Forty-one cases were confirmed by postoperative pathology, the coincidence rate of pathological diagnosis and endoscopic ultrasound diagnosis was 91.1% （41/45）. Conclusion Endoscopic ultrasound diagnosis is relatively accurate and can determine the nature and origin of lesions in protuberant lesions in upper gastrointestinal tract. Moreover, ultrasound gastroscope examination may provide reference for the selection of treatment methods.