超声内镜联合内镜下多环黏膜切除术治疗食管黏膜下肿瘤的价值

Value of endoscopic ultrasonography combined with endoscopic muti-band mucosectomy in the treatment of esophageal submucosal tumor

目的探讨超声胃镜（EUS）联合内镜下多环黏膜切除术（EMBM）治疗食管黏膜下肿瘤的可行性、安全性及有效性。方法对湖北医药学院附属太和医院消化内镜中心2011年8月至2013年2月收治的经普通胃镜、超声胃镜确诊的35例位于食管黏膜下肿瘤患者行内镜下多环黏膜切除术,标本送病理学检查,术后定期复查胃镜,评估患者疗效。结果 35例患者均手术成功。术后病检15例,与内镜活检标本符合率为93.3%（14/15）,20例未取检者超声胃镜符合率为95.0%（19/20）,超声胃镜总符合率为88.6%,有6例患者出现胸痛,其中2例行内镜下止血,患者无穿孔、感染、梗阻等并发症发生。术后2周复查创面无渗血、渗液,4周创面完全愈合形成疤痕,术后随访6个月～2年无患者复发。结论超声胃镜可以判断食管黏膜下肿瘤起源并初步定性,内镜下多环黏膜切除术操作简便、用时短,超声内镜联合内镜下多环黏膜切除术治疗食管黏膜下肿瘤安全性高、效果好,值得临床推广。

Objective To investigate the feasibility, safety and efficacy of endoscopic ultrasonography （EUS） combined with endoscopic muti-band mucosectomy （EMBM） in the treatment of esophageal submucosal tumor. Methods Thirty-five patients with esophageal submucosal tumors confirmed by ordinary endoscopy, EUS in the digestive endoscopy center of our hospital from Aug. 2011 to Feb. 2013 were treated by EMBM. Spec-imens were sent for pathological examination. Regular postoperative endoscopy was conducted to assess the clini-cal efficacy. Results Thirty-five patients all had successful surgery. Fifteen cases received postoperative pathological examination, with the compliance rate with endoscopic biopsy of 93.3%. For the 20 patients who did not take patho-logical examination, the compliance rate with EUS was 95.0%, and the total EUS compliance rate was 88.6%. Six pa-tients were found chest pain, of which two were performed routine endoscopic hemostasis. No case of perforation, in-fection, obstruction and other complications were observed. The wound was no longer oozing after two weeks and healed completely after four weeks with the formation of scar. No relapse was observed during the follow-up of 6~24 months. Conclusion EUS can determine the origin of esophageal submucosal tumor and and diagnose preliminary. EMBM is easy to operate and need shorter time. EUS combined with EMBM in the treatment of esophageal submuco-sal tumors has high safety and efficiency, which is worthy of promotion.