上消化道黏膜下病变套扎治疗的远期效果及其影响因素

Endoscopic band ligation of upper gastrointestinal submucosal lesions:long-term outcomes and risk factors

目的探讨经内镜下套扎治疗上消化道黏膜下病变的远期疗效和安全性,以及影响其治疗效果的影响因素。方法回顾性分析上消化道黏膜下病变橡皮环套扎治疗病例194例。通过远期随访获得治疗成功率,分析影响疗效的临床和内镜因素。以超声内镜结果为最终标准,分析普通内镜评估深浅层次的准确性。结果 194例中,套扎治疗完成184例,随访成功122例,通过内镜复查,套扎治疗成功率为90%。通过对比分析患者的一般情况及超声内镜影像特点,发现病变长径超过0.8 cm和所处深部层次是降低套扎治疗长期成功率的最重要影响因素。平片内镜对层次的评估与超声内镜对层次的评估不一致(Kappa值为0.04)。结论内镜下套扎术是治疗上消化道黏膜下病变安全有效的技术,但术后随访对疗效评估是必不可少的,超声内镜是术前评估是否适合该治疗方式的重要手段。

Objective To evaluate the long-term outcomes after endoscopic band ligation of upper gastrointestinal sub- mucosal lesions and risk factors. Methods Clinical and endoscopic data of 194 cases of upper gastrointestinal submu- cosal lesions undertaking endoscopic band ligation were retrospectively analyzed. The success rate of treatment and ad- verse effect were obtained during long-term follow-up. The accrate rate of common endoscopy in evaluating the depth of lesions was assessed according to endoscopic ultrasound reports. Results The ligation was accomplished in 184 cases （94.8%）, 90% of which were successful. Multivariable analysis showed that lesion diameter of more than 0.8cm and deep location were risk factors for the failure of ligation procedure. Evaluation of the depth of lesions by common white light endoscopy and endoscopic ultrasound was not comparable （ Kappa value 0.04）. Conclusion Endoscopic ligation of submucosal lesions in upper digestive tract is safe and effective, yet follow-up is necessary even for those who were thought to achieve success by the operators. And endoscopic ultrasound evaluation is essential before the procedure.