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目的总结超声内镜(EUS)检查对内镜黏膜下剥离术(ESD)和内镜黏膜下切除术(EMR)治疗上消化道黏膜及黏膜下病变的指导价值。方法选择2014年3月至2016年3月内蒙古科技大学包头医学院第二附属医院消化内镜中心发现的上消化道黏膜及黏膜下病变90例,术前EUS检查明确病变来源、侵犯层次及性质。根据EUS结果确定内镜下手术方式(ESD或EMR),记录手术过程、并发症、术后病理及随访结果。结果 90例病变,根据EUS检查结果,48例行ESD术,42例行EMR术。超声诊断与术后病理符合率达88.9%(80/90)。术后病理证实,2例ESD创面仍有病变残留,追加外科手术,其余88例病变完整切除,完整切除病变率97.8%(88/90)。2例EMR术中有少量出血,经电凝成功止血;5例ESD术中有少量出血,经电凝、氩离子血浆凝固术成功止血;1例ESD术后出现黑便,保守治疗后成功止血,出血发生率8.89%(8/90)。3例ESD术中出现1.0 cm穿孔,应用金属夹成功缝合穿孔,未转开腹手术,穿孔发生率3.3%(3/90)。术后随访55例,随访期3~6个月(平均4.2个月),创面愈合良好,均未见病变复发。结论 EUS检查对ESD和EMR治疗上消化道黏膜及黏膜下病变有较高的指导价值。
Objective To summarize the guiding value of endoscopic submucosal dissection (EUS) and endoscopic submucosal resection (EMR) in the treatment of upper gastrointestinal mucosa and submucosal lesions. Methods From March 2014 to March 2016, 90 cases of mucosal and submucosal lesions of the upper digestive tract were found in the digestive endoscopy center of the Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology. Preoperative EUS examination identified the origin of the lesions, the level and nature of the invasion . Endoscopic surgery (ESD or EMR) was performed based on EUS results. The surgical procedure, complications, postoperative pathology and follow-up were recorded. Results 90 cases of lesions, according to EUS test results, 48 cases of ESD, 42 cases of EMR. The coincidence rate between ultrasonic diagnosis and postoperative pathology was 88.9% (80/90). Postoperative pathology confirmed that two cases of ESD wound still residual disease, additional surgery, the remaining 88 cases of complete resection, complete resection lesions rate of 97.8% (88/90). A small amount of hemorrhage occurred in two cases of EMR, hemostasis was successfully achieved after electrocoagulation; a small amount of hemorrhage occurred in 5 cases of ESD, hemostasis was achieved by electrocoagulation and argon plasma coagulation; one case of melena after ESD was treated with hemostasis after conservative treatment , Bleeding rate was 8.89% (8/90). In 3 cases of ESD, a 1.0 cm perforation occurred. The metal suture was used to suture the perforation successfully. The perforation rate was 3.3% (3/90) without laparotomy. 55 cases were followed up for 3 to 6 months (average 4.2 months), the wound healing was good, and no recurrence was found. Conclusion The EUS examination has a higher guiding value for the treatment of upper gastrointestinal mucosa and submucosal lesions by ESD and EMR.