【摘要】：目的:探討上消化道粘膜下腫物(SMT)各類型病變的好發(fā)部位、在超聲內(nèi)鏡(EUS)下的表現(xiàn);通過結(jié)合內(nèi)鏡下治療及術(shù)后病理診斷,探討EUS對各種類型的SMT的診斷方面的價值,以及對此類病變的內(nèi)鏡下治療的指導(dǎo)作用。方法:選取2012年01月01日至2016年12月31日在廣西醫(yī)科大學(xué)第一附屬醫(yī)院行普通胃鏡檢查診斷為上消化道黏膜下腫物,并行超聲內(nèi)鏡檢查的患者270例作為研究對象,收集患者一般信息(姓名、性別、年齡、檢查日期、聯(lián)系電話等)、超聲內(nèi)鏡檢查結(jié)果(病變部位、來源層次、回聲特點)、是否行內(nèi)鏡下治療或外科手術(shù)、治療相關(guān)記錄、術(shù)后病理結(jié)果。結(jié)果:1、上消化道黏膜下腫物病變特點分析:本組270例SMT患者中,病變位于食管的有108例,占總例數(shù)40.00%,病變位于賁門的有5例,占總例數(shù)1.85%,病變位于胃內(nèi)145例,占總數(shù)的53.70%,12例的病灶位置在十二指腸,占總例數(shù)4.44%。黏膜肌層、固有肌層是食管病變的大部分來源,病變主要類型為平滑肌瘤;胃部病變主要來源于黏膜下層、固有肌層,病變主要類型為間質(zhì)瘤、異位胰腺。平滑肌瘤病變常見回聲表現(xiàn)為均勻、低回聲團塊,常見來源于黏膜肌層及固有肌層;間質(zhì)瘤的常見回聲表現(xiàn)為均勻、低回聲團塊,常見來源于固有肌層;異位胰腺其常見回聲表現(xiàn)為不均勻、低回聲團塊,常見來源于黏膜下層。2、上消化道黏膜下腫物病變治療及病理診斷分析:本組270例SMT患者中,有45例行內(nèi)鏡下黏膜切除術(shù)(EMR),54例行內(nèi)鏡下黏膜剝離術(shù)(ESD),3例行內(nèi)鏡經(jīng)黏膜下隧道腫瘤切除術(shù)(STER)。其中67例上消化道黏膜下腫物大小小于1cm,38例上消化道黏膜下腫物大小為1～3cm。EMR術(shù)中并發(fā)出血1例(占2.22%),ESD術(shù)中并發(fā)出血1例(占1.850%),穿孔5例(占9.26%)。本組病例通過對比超聲內(nèi)鏡診斷及病理診斷,89.06%的上消化道平滑肌瘤病例的EUS診斷與病理診斷相符,對于上消化道間質(zhì)瘤的EUS診斷的符合率53.13%,對于上消化道異位胰腺的EUS診斷的符合率52.63%。本組病例中通過病理診斷為炎癥14例,神經(jīng)內(nèi)分泌癌1例,癌前病變4例,上述病例的EUS診斷與病理診斷不符。結(jié)論:1.超聲內(nèi)鏡可通過探查上消化道黏膜下腫物病變部位、病變大小、來源層次、回聲高低、回聲是否均勻等,對病變作出超聲內(nèi)鏡診斷并為內(nèi)鏡下治療方案的選擇提供指導(dǎo)。2.在上消化道黏膜下腫物病變類型診斷方面,超聲內(nèi)鏡診斷與病理診斷符合率達72.88%,但超聲內(nèi)鏡對于診斷上消化道黏膜下炎癥、癌前病變、惡性腫瘤有一定局限性。
[Abstract]:Objective: to investigate the location of various types of (SMT) lesions in upper digestive tract submucosal tumor and the features of the lesions under endoscopic (EUS) (EUS). Combined with endoscopic therapy and postoperative pathological diagnosis, the value of EUS in the diagnosis of various types of SMT and its guiding role in endoscopic treatment of these diseases were discussed. Methods: from January 01, 2012 to December 31, 2016, 270 patients with upper digestive tract submucosal tumor diagnosed by general gastroscopy in the first affiliated Hospital of Guangxi Medical University were selected as study subjects. Collect general information of patients (name, sex, age, date of examination, contact number, etc.), results of endoscopic ultrasonography (location of lesion, level of origin, echo characteristics), whether or not endoscopic treatment or surgery, treatment related records, Postoperative pathological results. Results: 1. Analysis of the characteristics of upper digestive tract submucosal lesions: of the 270 cases of SMT, 108 cases were located in the esophagus, accounting for the total number of cases, and 5 cases were located in the cardia, accounting for 1.85% of the total cases. The lesions were located in the duodenum in 145 cases, accounting for 53.70% of the total. The lesions were located in the duodenum (4.44%). The mucosal myometrium and muscularis propria are the major sources of esophageal lesions, the main types of lesions are leiomyoma, and the gastric lesions are mainly derived from the submucosal layer, the lamina propria muscularis, and the main types of lesions are stromal tumors and ectopic pancreas. The echo of leiomyoma was homogenous, low echoic mass, usually originated from mucosal myometrium and propria myometrium, and the common echo of stromal tumor was homogenous, hypoechoic mass, and common origin from lamina propria muscularis. In ectopic pancreas, the common echogenic features were heterogeneity, hypoechoic mass and submucosal mass. 2. The treatment and pathological diagnosis of submucosal lesions of upper digestive tract: in this group of 270 cases of SMT, There were 45 cases of endoscopic mucosal resection (EMR), 54 cases of endoscopic mucosal dissection (ESD), 3 cases of endoscopic submucosal tunnel tumor resection (STER). In the 67 cases, the size of submucosal tumor of upper digestive tract was less than 1 cm ~ (-1). The size of the tumor of upper digestive tract was 1 case during 1~3cm.EMR (2.22%), 1 case (1.85%) complicated with hemorrhage during), ESD. Perforation occurred in 5 cases (9.26%). By contrast with endoscopic and pathological diagnosis, 89.06% of the patients with upper gastrointestinal leiomyoma were diagnosed by EUS, and 53.13% of the upper gastrointestinal stromal tumors were diagnosed by EUS. The coincidence rate of EUS diagnosis for ectopic pancreas of upper digestive tract was 52.63. In this group, 14 cases of inflammation, 1 case of neuroendocrine carcinoma and 4 cases of precancerous lesion were diagnosed by pathology. The EUS diagnosis of the above cases was not consistent with the pathological diagnosis. Conclusion: 1. Ultrasound endoscopy can provide guidance for endoscopic diagnosis of upper gastrointestinal tract submucosal tumor by exploring lesion location, lesion size, origin level, echo homogeneity and so on. 2. In the diagnosis of submucosal lesions of upper digestive tract, the coincidence rate between endoscopic and pathological diagnosis is 72.88. However, endoscopic ultrasonography has some limitations in the diagnosis of upper gastrointestinal submucosal inflammation, precancerous lesions and malignant tumors.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735

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