论文部分内容阅读
目的:探讨小探头超声内镜(miniprobe ultrasonography,MPS)在诊断及治疗大肠黏膜隆起性病变中的价值。方法:对经常规内镜检查提示的大肠黏膜隆起性病变患者行小探头超声内镜检查,了解病变的性质及来源,然后行针对性治疗。结果:2009年5月~2011年5月共54例患者,其中直肠25例,结肠22例,盲肠7例。根据小探头超声内镜检查结果,对其中44例黏膜隆起性病变根据病变大小及深度分别行圈套器高频电切除术、内镜黏膜切除术(endoscopic mucosal resection,EMR)或内镜黏膜下层剥离术(endoscopic submucosaldissection,ESD)等内镜下治疗,其中除结肠、盲肠囊肿及气囊肿5例外,余均送检病理,结肠、盲肠脂肪瘤6例,直肠类癌5例,大肠息肉28例,其中幼年性息肉2例,腺瘤18例,增生性息肉4例,炎性息肉4例;5例来源于固有肌层的间质瘤,其中3例直径小于1 cm的患者要求观察随访,2例行外科手术治疗,其中1例直肠巨大黏膜隆起病变小探头超声内镜来源显示不清,改为环形扫描超声内镜确定来源后再行外科手术治疗,结果均证明确实为来源于固有肌层的间质瘤;1例直肠淋巴瘤行外科手术治疗,超声内镜、内镜后病理及手术后病理均得到证实;还有2例肠腔外压迫,2例手术后改变。结论:小探头超声内镜能清楚显示消化道壁的层次及结构,对大肠黏膜隆起性病变的起源具有准确的定位作用,并能够提示病变的性质,对进一步的治疗有指导意义。
Objective: To investigate the value of miniprobe ultrasonography (MPS) in the diagnosis and treatment of mucosal protuberant lesions of large intestine. Methods: Ultrasound endoscopy was performed on patients with colonic mucosal lesions prompted by routine endoscopic examination to understand the nature and origin of the lesion, and then targeted therapy. Results: May 2009 ~ May 2011 a total of 54 patients, of which 25 cases of rectum, colon 22 cases, 7 cases of cecum. According to the result of endoscopic ultrasonography, 44 cases of mucosal protuberant lesions were treated by high-frequency electrosurgical excision of the snare, endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (Endoscopic submucosal disaction, ESD) and other endoscopic treatment, in addition to colon, cecal cysts and cysts in 5 cases, I were seized pathology, colon, cecal lipoma in 6 cases, rectal carcinoid in 5 cases, 28 cases of colorectal polyps, There were 2 cases of juvenile polyp, 18 cases of adenoma, 4 cases of hyperplastic polyps, 4 cases of inflammatory polyps, 5 cases of stromal tumors derived from muscularis propria, of which 3 cases with diameter less than 1 cm required follow-up, 2 Routine surgical treatment, including a case of rectal macular mucosal lesions small probe endoscopic ultrasonography source is unclear, replaced by ring-scan ultrasound endoscopic determination of source and then surgical treatment, the results are proven to be indeed derived from the muscularis propria Of the stromal tumors; 1 case of rectal lymphoma underwent surgical treatment, endoscopic ultrasound, endoscopic pathology and postoperative pathology have been confirmed; there are 2 cases of extraluminal compression, 2 cases of postoperative changes. Conclusion: The small probe ultrasound endoscopy can clearly show the level and structure of the digestive tract wall, with accurate localization of the origin of mucosal protuberant lesions, and can prompt the nature of the lesion, which is instructive for further treatment.