超声内镜与`内镜下黏膜切除术在食管黏膜肌层平滑肌瘤中应用.doc

超声内镜及内镜下黏膜切除术在食管黏膜肌层平滑肌瘤中的应用 　　[摘要] 目的 探讨超声内镜（EUS）对食管平滑肌瘤的诊断价值及内镜下黏膜切除术（EMR）治疗的效果。 方法 对经EUS检查拟诊为黏膜肌层平滑肌瘤进行EMR治疗的病例资料进行回顾性研究，分析病变部位的EUS图像、病理诊断结果及治疗效果。 结果 38例患者病变均完整一次性切除，病理均提示为起源于黏膜肌层的平滑肌瘤，术中基底部渗血5例，经处理后出血停止，无穿孔发生，术后复查胃镜所有病例创面愈合良好，无其他并发症发生。 结论 EUS诊断食管平滑肌瘤准确率高，EMR是治疗食管平滑肌瘤的微创、安全、有效、快捷的治疗手段 [关键词] 超声内镜；内镜下黏膜切除术；食管；平滑肌瘤 [中图分类号] R571 [文献标识码] B [文章编号] 1673-9701（2016）17-0000-03 Application of endoscopic ultrasonography and endoscopic mucosal resection in treatment of esophageal mucosal muscular layer liomyoma WANG Dongfang FANG Lifeng WANG Xiaoxia WANG Shujun CHEN Hongchao Department of Gastroenterology， Zhengzhou First People’s Hospital， Zhengzhou 450004， China [Abstract] Objective To discuss the value of endoscopic ultrasonography（EUS） in diagnosis of esophageal liomyoma and the effect of endoscopic mucosal resection（EMR）. Methods Cases of mucosal muscular layer liomyoma diagnosed by EUS were reviewed， and the EUS images， results of pathological diagnosis， and therapeutic effects were analyzed. Results Lesions of 38 patients were completely removed one time， and pathology all indicated muscular layer liomyoma. There were five cases of basal part errhysis during operation， and were controlled without perforation. Wound healing was favorable in all cases by gastroscope reexamination after operation， without other complications. Conclusion EUS has high accuracy rate in diagnosis of esophageal liomyoma， and EMR is a minimally invasive， safe， effective， and convenient method in treatment of esophageal liomyoma. [Key words] Endoscopic ultrasonography； Endoscopic mucosal resection； Esophagus； Liomyoma 食管平滑肌瘤（esophageal leiomyoma）是消化道常见的良性肿瘤，在上消化道内镜下常表现为黏膜下隆起型病变。主要见于食管，食管平滑肌瘤组织学来源主要为黏膜肌层或固有肌层。常规内镜下活检仅能取到黏膜层病变，黏膜下层病变相对稍深，一般不易取到，进而不能给予定性。对于黏膜下病变，超声内镜（endoscopic ultrasonography，EUS）则能探测到黏膜下层病变的起源层次、内部回声、实性还是囊性等基本情况；EUS由于敏感性、特异性更高因而成为最准确的检查方法[1]，成为了消化道疾病无创临床诊断的重要方法之一[2]，对于黏膜下病变，即往多采用外科手术切除，后来由于内镜下黏膜切除术（endoscopic mucosal resection，EMR）等微创技术的发展，目前黏膜下层及以上的病变均可通过E