现代医药卫生
現代醫藥衛生
현대의약위생
MODERN MEDICINE HEALTH
2015年
11期
1602-1605,1608
,共5页
刘艳萍%陈宏辉%李国庆%王正根
劉豔萍%陳宏輝%李國慶%王正根
류염평%진굉휘%리국경%왕정근
内窥镜检查%消化系统肿瘤/超声检查%黏膜%外科手术,微创性
內窺鏡檢查%消化繫統腫瘤/超聲檢查%黏膜%外科手術,微創性
내규경검사%소화계통종류/초성검사%점막%외과수술,미창성
Endoscopy%Digestive system neoplasms/ultrasonography%Mucous membrane%Surgical procedures,minimally invasive
目的探讨超声内镜对上消化道黏膜下肿瘤(SMT)的诊断价值及内镜微创手术切除SMT的疗效及安全性。方法对2013年10月至2014年12月该院胃镜检查发现的110例SMT患者进行超声内镜检查,根据检查结果选择不同治疗方案,其中行内镜下黏膜切除术(EMR)50例,内镜黏膜下剥离术(ESD)12例[其中内镜黏膜下挖除(ESE)术5例],黏膜下隧道内镜切除术(STER)1例,外科手术切除19例,行针状刀开窗及热活检钳烧灼7例。手术标本均进行病理学及免疫组化检查,总结超声内镜特点,并与最终诊断进行比较。术后定期进行内镜随访1~24个月,观察内镜微创治疗的安全性和有效性。结果110例患者经内镜超声检查诊断为平滑肌瘤29例,间质瘤39例,脂肪瘤12例,异位胰腺19例,囊肿7例,神经内分泌瘤4例。89例切除标本经病理检查表明病灶完整切除,切缘及基底部无病变组织残留,其中黏膜肌层病变39例,黏膜下层病变28例,固有肌层肿瘤22例。超声内镜诊断与术后病理学诊断肿瘤性质符合率为84.27%(75/89),来源层次符合率为87.64%(78/89)。2例出血、3例穿孔患者均在镜下给予钛夹夹闭,经保守治疗后痊愈。86例患者内镜术后随访期间未见复发或远期并发症。结论超声内镜指导下微创切除SMT是一种安全、有效的微创治疗方法。
目的探討超聲內鏡對上消化道黏膜下腫瘤(SMT)的診斷價值及內鏡微創手術切除SMT的療效及安全性。方法對2013年10月至2014年12月該院胃鏡檢查髮現的110例SMT患者進行超聲內鏡檢查,根據檢查結果選擇不同治療方案,其中行內鏡下黏膜切除術(EMR)50例,內鏡黏膜下剝離術(ESD)12例[其中內鏡黏膜下挖除(ESE)術5例],黏膜下隧道內鏡切除術(STER)1例,外科手術切除19例,行針狀刀開窗及熱活檢鉗燒灼7例。手術標本均進行病理學及免疫組化檢查,總結超聲內鏡特點,併與最終診斷進行比較。術後定期進行內鏡隨訪1~24箇月,觀察內鏡微創治療的安全性和有效性。結果110例患者經內鏡超聲檢查診斷為平滑肌瘤29例,間質瘤39例,脂肪瘤12例,異位胰腺19例,囊腫7例,神經內分泌瘤4例。89例切除標本經病理檢查錶明病竈完整切除,切緣及基底部無病變組織殘留,其中黏膜肌層病變39例,黏膜下層病變28例,固有肌層腫瘤22例。超聲內鏡診斷與術後病理學診斷腫瘤性質符閤率為84.27%(75/89),來源層次符閤率為87.64%(78/89)。2例齣血、3例穿孔患者均在鏡下給予鈦夾夾閉,經保守治療後痊愈。86例患者內鏡術後隨訪期間未見複髮或遠期併髮癥。結論超聲內鏡指導下微創切除SMT是一種安全、有效的微創治療方法。
목적탐토초성내경대상소화도점막하종류(SMT)적진단개치급내경미창수술절제SMT적료효급안전성。방법대2013년10월지2014년12월해원위경검사발현적110례SMT환자진행초성내경검사,근거검사결과선택불동치료방안,기중행내경하점막절제술(EMR)50례,내경점막하박리술(ESD)12례[기중내경점막하알제(ESE)술5례],점막하수도내경절제술(STER)1례,외과수술절제19례,행침상도개창급열활검겸소작7례。수술표본균진행병이학급면역조화검사,총결초성내경특점,병여최종진단진행비교。술후정기진행내경수방1~24개월,관찰내경미창치료적안전성화유효성。결과110례환자경내경초성검사진단위평활기류29례,간질류39례,지방류12례,이위이선19례,낭종7례,신경내분비류4례。89례절제표본경병리검사표명병조완정절제,절연급기저부무병변조직잔류,기중점막기층병변39례,점막하층병변28례,고유기층종류22례。초성내경진단여술후병이학진단종류성질부합솔위84.27%(75/89),래원층차부합솔위87.64%(78/89)。2례출혈、3례천공환자균재경하급여태협협폐,경보수치료후전유。86례환자내경술후수방기간미견복발혹원기병발증。결론초성내경지도하미창절제SMT시일충안전、유효적미창치료방법。
Objective To discuss ultrasonic endoscope′s diagnostic value in upper gastrointestinal tract submucosal tu-mor (SMT) and the curative effect and safety of using endoscope minimally invasive surgery to cut off submucosal tumor. Meth-ods Did ultrasonic endoscope on 110 SMT patients who did gastroscopy in this hospital from October ,2013 to December,2014. Different treatment were used in line with test results. 50 of them did endoscopic mucosal resection (EMR),12 of them did endo-scopic submucosal dissection(ESD)(5 ESE),1 of them did submucous tunnel endoscopic resection(STER),19 of them did sur-gical removal. Did pathology and immunohistochemical test on surgical samples. Summarized ultrasonic endoscope′s characteris-tics and made a comparison with ultimate diagnosis. Postoperative endoscope follow-up at regular intervals for 1-24 months was done to observe the safety and effectivity of endoscope minimally invasive surgery. Results 110 patients were diagnosed as li-omyoma(n=29),mesenchymoma(n=39),lipomyoma(n=12),heterotopic pancreas(n=19),cyst(n=7),neuroendocrine(n=4) by endoscope ultrasonic examination. 89 excision samples manifested complete focus excision by pathological examination. There was no lesion tissue residual in incisal edge and basilar part. There were 39 mucosal muscularis lesions ,28 submucosa lesions,22 muscularis propria tumors. The accordance rate of endoscope ultrasonic diagnosis and postoperative pathology diagnosis nature was 84.27%(75/89). The accordance rate of source level was 87.64%(78/89). 2 hemorrhage and 3 perforation patients were clipped under endoscope and cured using conservative treatment. 86 patients did not relapse or have long-term complications dur-ing postoperative follow-ups after endoscope surgery. Conclusions Using ultrasonic endoscope and endoscope minimally inva-sive surgery to cut off SMT is a safe and effective therapeutic method.