CAJ | 학술논문

背景：常规胃肠镜检查无法判断黏膜下病变的来源、大小和性质，小探头超声检查（MPS）对胃肠道管壁的分层识别能力强，能准确判断病变来源和性质，是拟诊黏膜下肿瘤患者术前检查的有效手段。目的：评价 MPS 对胃肠道黏膜下病变的诊断价值及其辅助内镜治疗的意义。方法：69例因拟诊胃肠道黏膜下隆起型病变行 MPS 检查并接受内镜治疗的患者纳入研究。入组患者根据 MPS 检查提示的病变来源、大小、性质等选择内镜治疗方式（包括囊肿切开、高频电圈套切除术、内镜黏膜切除术、内镜黏膜下剥离术），术后标本送病理检查。结果：69例病变中，MPS检查提示来源于黏膜肌层15例，黏膜下层40例，固有肌层14例；考虑囊肿10例，间质瘤18例，平滑肌瘤8例，异位胰腺6例，神经内分泌肿瘤15例，脂肪瘤12例。MPS 与病理诊断的总体符合率为91.3%（63/69）。结论：内镜治疗前的 MPS 检查判断胃肠道黏膜下隆起型病变的来源和性质准确性高，对治疗方式的选择具有指导意义。
배경：상규위장경검사무법판단점막하병변적래원、대소화성질，소탐두초성검사（MPS）대위장도관벽적분층식별능력강，능준학판단병변래원화성질，시의진점막하종류환자술전검사적유효수단。목적：평개 MPS 대위장도점막하병변적진단개치급기보조내경치료적의의。방법：69례인의진위장도점막하륭기형병변행 MPS 검사병접수내경치료적환자납입연구。입조환자근거 MPS 검사제시적병변래원、대소、성질등선택내경치료방식（포괄낭종절개、고빈전권투절제술、내경점막절제술、내경점막하박리술），술후표본송병리검사。결과：69례병변중，MPS검사제시래원우점막기층15례，점막하층40례，고유기층14례；고필낭종10례，간질류18례，평활기류8례，이위이선6례，신경내분비종류15례，지방류12례。MPS 여병리진단적총체부합솔위91.3%（63/69）。결론：내경치료전적 MPS 검사판단위장도점막하륭기형병변적래원화성질준학성고，대치료방식적선택구유지도의의。
Background:Conventional gastrointestinal endoscopy is incapable of determining the deriving layers,size and nature of submucosal lesions,however,mini probe ultrasonography(MPS)is effective for mural stratification and determining the deriving layers and nature of lesions within gastrointestinal wall,and is considered to be an optimal examination for suspected submucosal tumors before endoscopic or surgical operation. Aims:To assess the diagnostic value of MPS for gastrointestinal submucosal lesions and the significance of MPS-assisted endoscopic therapy. Methods:A total of 69 patients with presumed gastrointestinal submucosal protruded lesions were retrospectively enrolled. All of them underwent MPS and then endoscopic therapy,such as cyst incision,high frequency electric snare resection,endoscopic mucosal resection and endoscopic submucosal dissection were performed according to the deriving layers,size and nature determined by MPS. The ultimate diagnosis was confirmed by histopathological examination. Results:In the 69 cases of lesions,MPS showed that 15 were derived from muscularis mucosa,40 from submucosa,and 14 from muscularis propria;10 of them were considered as cyst,18 were stromal tumor,8 were leiomyoma,6 were ectopic pancreas,15 were neuroendocrine tumor,and 12 were lipoma. Compared with pathological diagnosis,an overall coincidence rate of 91. 3%(63 / 69)was achieved by MPS. Conclusions:The accuracy rate of MPS is high for determining the deriving layers and nature of gastrointestinal submucosal protruded lesions prior to the attempting of endoscopic removal. It might be helpful for selecting treatment modalities for this kind of lesions.