电子线阵式超声内镜在消化道黏膜下肿瘤诊断及治疗的临床应用

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1、电子线阵式超声内镜在消化道黏膜下肿瘤诊断及治疗的临床应用卢水蓉杨小青李琴陆金来徐春华唐荣萍胥明通讯作者同济大学附属东方医院消化内科上海200233作者简介:卢水蓉，女,(1971一硕士学位，主治医师，胃肠道疾病的诊断及治疗，擅长于胃肠镜、超声内镜的镜下诊断及治疗，消化道出血的镜下治疗，就职于上海市同济大学附属东方医院消化内科.【摘要】A的评价电子线阵式超声内镜对消化道黏膜不肿瘤的诊断及治疗价值，探讨电子线阵式超声A镜指导下A镜微创治疗消化道黏膜下肿瘤的有效性和安全性.方法经H肠镜、超声内镜诊断起源于消化道粘膜下肿瘤的患者89例，壁层肿瘤76例，腔外压迫13例.直径≤1.0cm的壁

2、层粘膜下肿瘤采用内镜下高频电圈套切除术，直径〉1.0cm的采用内镜黏膜K剥离术(ESD)切除肿瘤.结果EUS证实13例为腔外压迫,64例为壁层肿瘤并在内镜下完全切除.12例手术切除.病理组织学显示间质瘤26例，平滑肌瘤14例，类癌14例，脂肪瘤3例，囊肿6例，异位胰腺8例，淋巴管瘤1例.3例术屮发生创面出血，用高频电凝止血，未发生其他与手术相关的并发症.术后6个月随访,所有患者创面均形成Q色溃疡瘢痕.4例囊肿采用经内镜直视下穿刺术治疗；12例外科手术治疗.3例保守支持对症治疗,8例随访.结论电子线阵式超声内镜为消化道粘膜下隆起的诊断及治疗提供丫一条安全有效的新途径，而且对病变的评估及后

3、续治疗具有重要的指导价值.【关键词】黏膜下肿瘤；电子线阵式超声内镜；内镜治疗术Applicationsofelectronicbeamscanningendoscopicultrasonographyinthediagnosisandanddifferentialdiagnosisofdigestivetractsubmucosaltumors【Abstract】ObjectiveToevaluatethediagnosticandtherapeuticvalueofelectronicbeamscanningendoscopicultrasonographyandtoexploret

4、hesafetyandefficacyofendoscopictherapyintreatmentofthedigestivetractsubmucosaltumors.Methods:eighty—ninepatientswhowerediagnosedasdigestivetractsubmuGcosaltumorbygastroscopyandelectronicbeamscanningendoscopicultrasonography.Amongthese76casesareoriginatedfromthemucouslayer,13casesareexGtraluminal

5、compression;Highfrequencyelectrictrappedresectionwasappliedtoremovesubmucosaltumorswithdiameterslessthan1.0cm,andendoscopicsubGmucosaldissectionwasappliedtoremovetumorsbiggerthan1.0cm.Results:Thedigestivetractsubmucosaltumorsofthe64patientswerecompletelyresected.H,istopathologicalandimmunohistoc

6、hemicalexaminationsconfirmed32casesofstromaltumors,18casesofleiomyomas,15casesofcarcinoid,10casesofLipomaand6patientofsubmucouscyst,5casesofectopicpancreas,2casesofhemangioma;3patienthadintraoperativebleedingthatwasstoppedbyelectrocoagulationhemostasis.Nootheroperation—relatedcomplicationsoccurr

7、ed.After6monthsfollow—up,endoscopyshowedthatthewhiteulcerousscarsformedinallpatients-4casesofcystsusingthehematomaloopligationtreatmentendoscopy,12casesweretreatedbysurgery,3casesacceptedconservativesupportsymptomatictreatGm