CT、超声胃镜及内镜下肿瘤挖除术对上消化道异物包埋的诊疗价值

Clinical analysis of CT,endoscopic ultrasonography and endoscopic submucosal excavation treatment of embedding foreign bodies in upper gastrointestinal tract

目的 分析上消化道异物包埋患者的胃镜、超声胃镜(EUS)、CT等影像学特点,及采用内镜下肿瘤挖除术(ESE)的方式处理异物包埋的临床疗效,以提高临床对上消化道异物包埋疾病的诊治水平.方法 对12例已经手术、内镜或临床确诊的上消化道异物包埋患者的临床表现及影像资料、手术情况进行回顾性分析.结果 12例患者无明确的异物吞服史;临床表现为慢性腹痛,反复发作;异物位于食管1例、胃11例.异物的影像学表现:CT表现为上消化道管壁的致密影,伴脂肪间隙正常或模糊;胃镜表现为病灶隆起,类似黏膜下肿瘤;EUS表现为不规则低回声或不规则低回声伴高回声改变.临床处理:2例病灶表面深挖活检后利用异物钳或圈套器将异物取出体外,10例采用ESE的方式取出包埋的异物.患者症状均消失.结论 CT、胃镜、超声胃镜三者联合对上消化道异物包埋的诊断有效,ESE手术对于上消化道管壁异物包埋的治疗安全、有效.

Objective To evaluate the value of CT and endoscopic ultrasonography(EUS) in the diagnosis of embedding foreign bodies in upper gastrointestinal tract;to analyze the security and effect of endoscopic submucosal excavation(ESE) dealing with embedding foreign bodies in upper gastrointestinal tract. Methods During the period of June 2010 to September 2019,a total of 12 cases about embedding foreign bodies in upper gastrointestinal tract in our hospital were involved in this study.The clinical and imaging data of those cases confirmed by clinic were retrospectively analyzed. Results There were all not identifying history about swallowing foreign bodies. Most of them had repeated chronic abdominal pain.In all the 12 cases,1 case was in the esohgagus,11 cases were in the stomach. Hyperdensity were found in the Gastrointestinal wall,and the wall were thickened in CT.Those cases had the mucoscal protrusion like the submucosal tumor(SMT) in gastroendscop and EUS.In EUS, irregular hypoechoic or irregular hypoechoic accompanied by hyperechoic changes were observed.The foreign bodies of two patients were successfully removed by deep excavation biopsy and with the help of foreign body forceps and snares.The other patients were healed successfully by ESE.Conclusion Besides helping in the diagnosis of embedding foreign bodies in upper gastrointestinal tract, CT and gastroendscop and EUS can also provide guidance for clinical treatment.Taking out embedding foreign bodies in upper gastrointestinal tract by ESE can reduce the complications and improve the success rate.ESE is a security and effective method about dealing with the embedding foreign bodies.