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.docVIP

精品论文 参考文献 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－),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】　目的　评价电子线阵式超声内镜对消化道黏膜下肿瘤的诊断及治疗价值,探讨电子线阵式超声内镜指导下内镜微创治疗消化道黏膜下肿瘤的有效性和安全性.方法　经胃肠镜、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le;１．０cm 的壁层粘膜下肿瘤采用内镜下高频电圈套切除术,直径＞１．０cm 的采用内镜黏膜下剥离术(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例术中发生创面出血, 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白色溃疡瘢痕.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了一条安全有效的新途径,而且对病变的评估及后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】　ObjectiveToevaluatethediagnosticandtherapeuticvalueofelectronicbeamscanningendoscopicultrasonographyandtoexplorethesafetyandefficacyofendoscopictherapyintreatmentofthedigestivetractsubmucosaltumors．Methods:eighty－ninepatientswhowerediagnosedasdigestivetractsubmuＧcosaltumorbygastroscopyandelectronicbeamscanningendoscopicultrasonography．Amongthese７６casesareoriginatedfromthemucouslayer,１３casesareexＧtraluminalcompression;Highfrequencyelectrictrappedresectionwasappliedtoremovesubmucosaltumorswithdiameterslessthan１．０cm,andendoscopicsubＧmucosaldissectionwasappliedtoremovetumorsbiggerthan１．０cm．Results:Thedigestivetractsubmucosaltumorsofthe６４patientswerecompletelyresected．H,istopathologicalandimmunohistochemicalexaminationsconfirmed３２casesofstromaltumors,１８casesofleiomyomas,１５casesofcarcinoid,１０casesofLipoma and６patientofsubmucouscyst,５casesofectopicpancreas,２casesofhemangioma;３patienthadintraoperativebleedingthatwasstoppedbyelectrocoagulationhemostasis．Nootheroperation－relatedcomplicationsoccurred．After６monthsfollow－up,endoscopyshowedthatthewhiteulcerousscarsformedinallpatients．４casesofcystsusingthehematomaloopligationtreatmentendoscopy,１２casesweretreatedbysurgery,３case