上消化道黏膜下肿瘤行内镜超声微创治疗的临床观察

Clinical observation of endoscopic ultrasound minimally invasive treatment for upper gastrointestinal submucosal tumors

目的探究上消化道黏膜下肿瘤行内镜超声微创治疗的效果。方法选取2017年9月—2019年9月河北北方学院附属第一医院收治的174例上消化道黏膜下肿瘤患者为研究对象,均实施内镜下黏膜剥离术。观察上消化道黏膜下肿瘤的性质、起源和分布;以病理诊断为“金标准”,观察消化内镜的诊断符合率;比较治疗前后糖类抗原(CA)15-3、癌胚抗原(CEA)、CA19-9及肿瘤特异性生长因子等血清肿瘤标志物水平;记录并发症的发生情况。结果食管病变以食管平滑肌瘤最多,主要分布于胸下段、胸上段,多起源于黏膜肌层,回声特点为低回声。内镜超声检查诊断符合率为99.42%。治疗后CA15-3、CEA、CA19-9、肿瘤特异性生长因子水平低于治疗前,差异均有统计学意义(均P<0.05)。进行微创治疗后,9例患者术后24 h出现明显上腹痛或胸骨后疼,3例出现穿孔,7例术后出现明显出血,给予针对性处理后,均已好转。结论对上消化道黏膜下肿瘤给予内镜超声微创治疗,不仅可帮助临床对患者进行诊断,还可进行相应的治疗,且并发症少,安全性高,值得应用与推广。

Objective To explore the effect of endoscopic ultrasound minimally invasive treatment for upper gastrointestinal submucosal tumors.Methods A total of 174 cases with upper gastrointestinal submucosal tumors in the First Affiliated Hospital of Hebei North University from September 2017 to September 2019 were selected as research objects.All patients underwent endoscopic mucosal dissection.The nature,origin and distribution of upper gastrointestinal submucosal tumors were observed.The diagnostic coincidence rate of digestive endoscopy was observed,pathological diagnosis as the“gold standard”.The levels of serum tumor markers including carbohydrate antigen(CA)15-3,carcinoembryonic antigen(CEA),CA19-9 and tumour-specific growth factor were compared before and after treatment.The incidence of complications was recorded.Results Esophageal leiomyoma is the most common esophageal lesion,mainly distributed in the lower thoracic segment and upper thoracic segment,mostly originated from the muscular mucosa,and the echo characteristic is hypoecho.The diagnostic coincidence rate of endoscopic ultrasound was 99.42%.The levels of CA15-3,CEA,CA19-9 and tumor-specific growth factor after treatment were lower than those before treatment,with statistical significance(all P<0.05).After minimally invasive treatment,nine patients developed obvious epigastric pain or retrosternal pain 24 h after surgery,three patients developed perforation,and seven patients developed significant postoperative bleeding.All patients were improved after targeted treatment.Conclusion Endoscopic ultrasound minimally invasive treatment for upper gastrointestinal submucosal tumors can not only help the clinical diagnosis of patients,but also provide corresponding treatment,with few complications and high safety,which is worthy of application and promotion.