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目的探讨在超声内镜(endoscopicultrasonography,EUS)辅助下,针对胃及食管间叶源性肿瘤的个性化治疗方法。方法患者选择标准:(1)最大直径<2.0cm起源于黏膜肌层的黏膜下肿瘤(submucosal tumor,SMT)。(2)最大直径<1.2cm起源于固有肌层的SMT。(3)肿瘤向腔内生长。(4)无肿瘤转移的其他影像学证据。入选病例25例,其中男15例,女10例。采用内镜下黏膜切除术(endoscopic mucosal resection,EMR)方法治疗黏膜肌层的肿瘤,固有肌层的肿瘤采用结扎方法。结果 6例病变位于胃固有肌层的SMT(胃底4例,胃体1例,胃窦1例)采取内镜下结扎方法治疗;19例食管黏膜肌层SMT采取内镜下EMR治疗。25例治疗过程中均未发生出血及穿孔,术后复查超声内镜创面愈合,病变无残留。结论 EUS在选择间叶源性肿瘤治疗方式方面具有积极的作用,可为病人选择个性化治疗,使内镜下治疗更安全、有效。起源于固有肌层的肿瘤,采用内镜下结扎治疗,与内镜下剥离治疗相比,创伤小、并发症少,不失为一种好的治疗办法。
Objective To explore the personalized treatment of gastric and esophageal mesenchymal tumors with the aid of endoscopic ultrasound endoscopy (EUS). Methods Patient selection criteria: (1) Submucosal tumor (SMT) originating from the muscularis mucosa with a maximum diameter of <2.0 cm. (2) The largest diameter <1.2cm originated in the muscularis SMT. (3) tumor growth to the cavity. (4) No other imaging evidence of tumor metastasis. Selected cases of 25 cases, including 15 males and 10 females. Endoscopic mucosal resection (EMR) was used to treat tumors in the muscularis mucosa. Tumors in the muscularis propria were ligated. Results SMT (gastric fundus in 1, stomach in 1, gastric antrum in 6 patients with lesions in the stomach) was treated by endoscopic ligation. Nineteen patients with SMT underwent endoscopic EMR treatment. No bleeding and perforation occurred in 25 cases during the course of treatment. Ultrasonic endoscopic wound healing was observed after operation, and there was no residual disease. Conclusion EUS plays a positive role in the selection of mesenchymal tumors and can be used as a personalized therapy for endometriosis. Endoscopic treatment is safer and more effective. Originated from the muscularis propria of the tumor, endoscopic ligation treatment, compared with endoscopic stripping treatment, trauma, fewer complications, after all, a good treatment.