内镜超声检查术引导下介入诊治老年上消化道及消化壁外占位病变的临床价值

发布时间：2018-05-04 11:33

本文选题：内镜 + 微探头超声　；参考：《中国老年学杂志》2015年03期

【摘要】：目的探讨内镜超声检查术(EUS)引导下介入(EUS-FNI)诊治老年上消化道及消化壁外占位病灶的临床价值。方法选择经胃镜检查发现并收治入院的≥60岁老年上消化道及消化壁外占位病变患者30例诊断和治疗资料进行回顾性分析。结果 30例老年上消化道及消化壁外占位病灶患者胃镜总体诊断准确率为14例(46.67%),EUS引导下细针穿刺活检(EUS-FNA)诊断总体准确率为76.67%,与胃镜比较差异有统计学意义(χ2=8.246,P0.05)。3例癌性疼痛患者采用EUS引导下腹腔神经节阻滞术(EUS-CPN)后当日患者疼痛明显减轻,疼痛VAS为5~6分,平均疼痛评分(8.2±1.7)分,疼痛缓解起效时间平均为(5.0±1.2)h,疼痛缓解持续时间(32.5±9.5)d;2例囊腺瘤患者采用保守观察;25例上消化道占位病变患者采用内镜黏膜下剥离术(ESD)治疗,手术平均时间(38.5±12.3)min;22例患者均一次性切除,1例胃间质瘤患者术中出现大出血转外科手术治疗,2例食管平滑肌瘤术中剥离困难转外科治疗。结论 EUS-FNI对老年上消化道及消化壁外占位病灶能做出较准确的判断,应作为内镜下治疗的术前常规检查。内镜超声引导下介入治疗上消化道黏膜下隆起性病变安全、有效。
[Abstract]:Objective to investigate the clinical value of endoscopic ultrasonography (EUS) guided interventional therapy (EUS-FNI) for the diagnosis and treatment of the upper digestive tract and outer space occupying lesions in the upper digestive tract. Methods the data of 30 cases of the upper digestive tract and the extra digestive tract occupying lesions of the aged 60 years old were reviewed and analyzed by gastroscopy. The results of 30 cases were analyzed. The overall accuracy of gastroscope diagnosis was 14 (46.67%) in the elderly patients with upper digestive tract and external digestive tract occupying lesions. The overall accuracy rate of EUS guided fine needle aspiration biopsy (EUS-FNA) was 76.67%, and there was a statistically significant difference from gastroscope (x 2=8.246, P0.05) in.3 cases with cancer pain after EUS guided celiac ganglion block (EUS-CPN). On that day, the pain was significantly reduced, the pain VAS was 5~6, the average pain score was (8.2 + 1.7), the onset time of the pain relief was (5 + 1.2) h, the pain relieved duration (32.5 + 9.5) d, 2 cases of cystadenoma patients were conservative, and the patients with upper digestive tract occupying lesions were treated with endoscopic submucosal dissection (ESD), and the average time of operation was 3 8.5 + 12.3) min, 22 cases were all excised in one time, 1 cases of gastric stromal tumor were treated with large hemorrhage and surgical treatment, 2 cases of esophageal leiomyoma were dissection and transsurgical treatment. Conclusion EUS-FNI can make a more accurate judgement on the upper digestive tract and the outer space occupying lesion of the digestive tract, and should be used as the routine examination before endoscopic treatment. Endoscopic ultrasonography guided interventional treatment of submucosal protuberances of upper gastrointestinal tract is safe and effective.

【作者单位】：暨南大学附属第一医院;
【分类号】：R445.1;R57

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