小探头超声内镜联合CT 检查对较大胃黏膜下肿瘤治疗方案选择的价值.docVIP

小探头超声内镜联合CT检查对较大胃黏膜下肿瘤治疗方案选择的价值 王　军，樊丽琳，沈小春，孙文静，李 平，兰春慧，陈东风，胡 辂 （400042 重庆，第三军医大学大坪医院野战外科研究所消化内科） [摘要] 目的 评价小探头超声内镜联合CT 检查对较大胃黏膜下肿瘤诊疗中的作用，以此指导临床治疗方案的选择。方法 小探头超声内镜发现胃黏膜下肿瘤52 例，超声剖面直径≥20mm，结合腹部64排螺旋CT 检查，判断肿瘤的位置、来源、周围及远处器官转移等情况，对腔内生长未累及浆膜的肿瘤行ESD治疗，对侵及浆膜和向腔外生长的行腹腔镜或剖腹手术治疗，所有切除标本送常规病理检查及免疫组化检测，半年后对患者进行胃镜及CT随访。结合疗效来来评价小探头超声内镜联合CT 检查在较大胃黏膜下肿瘤治疗过程中的作用。结果 良性间质瘤20例，恶性间质瘤16例，平滑肌瘤5例，异位胰腺6例，脂肪瘤5例，CT提示30例腔内生长，未侵犯浆膜，无周围器官转移，予内镜下ESD治疗，仅有2例穿孔，经钛夹夹闭和保守治疗好转。其余22例CT检查为腔内或腔外生长予外科手术或腹腔镜治疗。术后3个月复查，所有病变愈合好，无复发。结论 小探头超声内镜联合T对较大胃黏膜下肿瘤进行检查，可获得较准确的病变情况，对胃黏膜下较大的肿瘤治疗方案的选择具有重要的指导意义。 [关键词] 小探头超声内镜；体层摄影术，X线计算机；黏膜下肿瘤 [中图法分类号] [文献标志码] A The role of miniprobe ultrasonography associated with CT examination in diagnosis and treatment of the larger gastric submucosal tumors Wang Jun, Fan Lilin,Sheng Xiaochun,Sun Wenjing,Lipin,Lan Chunhui,Chen Dongfeng,Hu Lu(Department of gastrointestinal,Daping Hospital and the Research Institute of Surgery of the Third Military Medical University Chongqing ,400042) [Abstract] Objective To evaluate the role of miniprobe ultrasonography associated with CT examination in diagnosis and treatment of of the larger gastric Submucosal Tumors（SMT）, and its effect and safety of guiding the treatment by endoscopy.Methods 52 patients with small gastric probe EUS detected SMT，ultrasound cross-section diameter ≥ 20mm, were associated with abdominal CT examination to determine the location of tumor invasion, depth, surrounding and distant organ metastasis, etc. Gastric submucosal tumors growth to the gastric lumen, not involving the serosa of the stomach, were stripped by endoscopic submucosal dissection (ESD).The tumors invading the serosa, and growth to the outside of the stomach cavity, were received laparoscopic or laparotomy treatment. All resected specimens were sent to the routine pathological examination and immunohistochemistry. Six months later, all patients were followed up by endoscopy and CT. Combined with the res