微探头超声内镜辅助内镜治疗消化道黏膜下肿物291例临床分析

Clinical analysis of endoscopic treatment of 291 cases of submucosal tumors in digestive tract by miniprobe endoscopic ultrasonography

目的探讨超声内镜对消化道黏膜下肿物的定性和定位诊断的准确率分析,以及在其内镜辅助下多种微创治疗的安全性和有效性比较。方法选取2015年5月—2017年4月期间蚌埠医学院第一附属医院291例行微探头超声内镜检查患者,依据检查结果,选择不同内镜下手术方式,如内镜黏膜下隧道肿瘤切除术(STER)、内镜下全层切除术(EFR)、内镜下黏膜剥离术(ESD)等。术后记录病理结果,对获得的病理诊断结果与超声诊断结果进行比较,并观察治疗成功率,有无中转外科腹腔镜或开腹,术中术后并发症情况及处理。评价超声内镜诊断及内镜治疗效果,术后定期门诊及内镜随访。结果微探头超声内镜定性诊断准确率为70.43%,定位诊断准确率为87.90%。术中6例穿孔,1例搏动性出血,1例贲门黏膜撕裂,均行钛夹封闭。1例EFR术中见搏动性出血,热活检钳止血。4例STER术中皮下气肿,保守治疗后消失。4例因术中活动性出血,止血失败或视野不清,中转开腹手术治疗。1例STER术中无法分离肿瘤,取活检病理示:鳞状细胞癌,结合病史,考虑肿瘤转移。其余肿物均成功切除,无明显术中术后并发症,内镜完整切除率为97.45%。结论微探头超声内镜对消化道黏膜下肿物的定性和定位诊断有较高准确率,特别是定位诊断有助于安全的选择内镜下微创治疗。

Objective To explore the diagnostic and diagnostic accuracy of endoscopic ultrasonography( EUS) in the diagnosis and localization of submucosal masses in digestive tract and the safety and efficacy of minimally invasive treatment under the guidance of endoscopy. Methods A total of 291 patients underwent gastrointestinal miniprobe sonography from May,2015 to April,2017 in Bengbu Medical College. According to the results,the endoscopic surgical procedures,such as endoscopic submucosal tunnel resection( STER),endoscopic resection( EFR),endoscopic mucosal dissection( ESD),and so on,were selected. The pathological results were recorded and compared with the results of ultrasonography. The success rate of treatment,the presence of laparoscopic or laparotomy,the postoperative complication and its treatment were observed. The effectiveness of endoscopic ultrasonography and endoscopic treatment were evaluated. The postoperative regular endoscopic follow-up was carried out. Results The accuracy of miniprobe sonography diagnosis was 70. 43%,and the accuracy of localization was 87. 90%. There were 6 cases of intraoperative perforation,1 case of pulsatile bleeding,and 1 case of mucosal laceration in gastric cardia,which were all closed with titanium clip. One case of pulsatile bleeding during EFR surgery was stopped by hot spoon forceps. Four cases of subcutaneous emphysema during STER disappeared after conservative treatment. Four cases of intraoperative active bleeding,with fail hemostasis or unclear vision,were converted to laparotomy surgery. One case of tumor could not be dissected during STER surgery and be sampled for a biopsy,and the examination showed it was squamous cell carcinoma,which was suspected to be tumor metastasis on the basis of history.Other tumors were successfully removed,without significant postoperative complications. The endoscopic resection rate for complete tumor was 97. 45%. Conclusion Gastrointestinal miniprobe sonography has a high degree of qualitative and localized diagnostic accuracy for digestive tract submucosal masses. In particular,the diagnosis of localization is helpful for safe selection of endoscopic minimally invasive treatment.