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目的探讨电子超声内镜(endoscopic ultrasonography,EUS)结合内镜下黏膜切除术(endoscopic mucosalresection,EMR)、内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)、内镜黏膜下挖除术(endoscopicsubmucosal excavation,ESE)及外科手术在食管黏膜层及黏膜下病变诊断和治疗中的作用。方法对2010年1月至2012年1月常规电子内镜检查发现食管黏膜层及黏膜下病变行EUS检查患者118例共120处病灶。将EUS拟诊诊断与内镜下手术及外科手术术后病理结果(包括病理类型、起源)进行统计分析,分析其符合率。结果黏膜层病变术后病理与EUS拟诊符合率为100%(16/16),分层诊断准确率为93.75%(15/16);黏膜下病变术后病理与EUS拟诊符合率为88.5%(92/104),分层诊断准确率为97.1%(101/104);本研究中,所有病变术后病理与EUS拟诊的总体符合率为90%(108/120),总体分层诊断准确率为96.7%(116/120)。结论 EUS能准确地显示食管各层结构、判断肿瘤的起源,较准确地估计肿瘤的性质。对于食管肿瘤治疗方式的选择、扩大内镜下手术治疗适应证、指导外科手术治疗,均能起到较好的作用,应在治疗前常规应用。对黏膜下病变,提倡在EUS的指导下进行早期干预。
Objective To investigate the clinical value of endoscopic ultrasonography (EUS) combined with endoscopic mucosal rection (EMR), endoscopic submucosal dissection (ESD), endoscopicsubmucosal excavation , ESE) and surgery in the diagnosis and treatment of esophageal mucosa and submucosal lesions. Methods From January 2010 to January 2012, 118 patients with EUS in esophageal mucosa and submucosal lesions under conventional electronic endoscopy were found to have a total of 118 lesions. The diagnosis of EUS and endoscopic surgery and surgical postoperative pathological results (including pathological type, origin) were analyzed statistically, the coincidence rate. Results The coincidence rate of postoperative pathology and EUS diagnosis of mucosal lesions was 100% (16/16), and the accuracy of stratified diagnosis was 93.75% (15/16). The coincidence rate of submucosal pathology and EUS was 88.5 % (92/104). The accuracy of stratified diagnosis was 97.1% (101/104). In this study, the overall coincidence rate of postoperative pathology and EUS diagnosis of all the lesions was 90% (108/120). The overall stratification The diagnostic accuracy was 96.7% (116/120). Conclusion EUS can accurately display the structure of esophageal layers, to determine the origin of the tumor, more accurately estimate the nature of the tumor. For esophageal cancer treatment options, to expand the indications for endoscopic treatment, surgical guidance, can play a good role, should be routinely used before treatment. Submucosal lesions, to promote early intervention under the guidance of the EUS.