The Clinical Research Of Intrinsic Muscular Layer Of The Stomach Lesions' Identification And Treatment Options Of Endoscopic Ultrasonography

objective: To explore a new way to improve the diagnostic accuracy of gastric muscular propria,this research combines photoshop techniques with endoscopic ultrasonography and uses Photoshop to quantify gastric muscular lesions' images of echo intensity and echo uniformity,with subjective judgments converted to objective data.To increase discrimination of the "cases of difficult opreation",this research retrospectively summarizes the endoscopic ultrasonography and pathological features of the "cases of difficult opreation" to guide the endoscopic treatment's selection and to remind operators of operation attention.Methods :Part one:This research selected gastric muscularis propria lesions as the objects,divided them into four groups according to pathological and immunohistochemical results.Firstly,made a judgment subjectively of echo intensity grading,then used Phototshop to quantify the gray value representing echo intensity objectively.This study compared the gray value of the same echogenicity in all pathological lesions,then compared the gray value of the four kinds of pathological lesions.The same as before,subjectively judged of four types of lesions echogenic uniformity,indicators for the uniform,less uniform,uneven.Photoshop was used to quantify gray level standard deviation representing echo uniformity objectively.This study compared the gray level standard deviation of the same echogenicity in all pathological lesions,then compared the echo uniformity of the four kinds of pathological lesions.Part two: Selected all gastric muscularis propria lesions with endoscopic treatment,further selecting out the cases of operation time too long,more intraoperative blood loss,intraoperative complications operation time is too long,intraoperative blood loss,intraoperative(such as a large number of bleeding and the perforation can not repair)leading to surgery supplement,ESD perforation as the cases of difficult operation as the research object.Generalized the characteristics of endoscopic ultrasonography,the features of difficult operation included of different pathological types,different diameters,different operating methods.Results:1)There was a statistically significant difference between the group of level one echo gray value(F=8.97,P=0.000).There was a statistically significant difference between the group of level two echo gray(F=5.48,P=0.003).There was a statistically significant difference between the gray-value group of the group of gastric stromal tumor,gastric leiomyoma,gastric heterotopic pancreas at level three(F=3.60,P=0.047).The overall difference of the four types of lesions was statistically significant(F=12.39,P=0.000).2)In the uneven echo,there was a statistically significant difference between the gray level standard deviation of the four lesion types(F=3.89,P=0.023);In uniform echo,there was a statistically significant difference between the gray level standard deviation of the four groups of lesions types(F=7.11,P=0.000).There was a statistically significant difference between the groups in the less uniform echo of gastric stromal tumor group,gastric schwannoma group and heterotopic pancreas group(F=4.73,P=0.020).The overall difference of the four types of lesions was statistically significant(F=11.80,P=0.000).3)The relationship of "cases of difficult opreation" : diameterd <1cm lesions perforation rate was highest,the group of the diameter of 1?d <2cm including 18 cases,including 3 cases of ESD in operating changed EFTR,5 cases with perforation;The diameter of 2?d<4,including 12 cases,two of them were turned to surgery for the reason of hemorrhage.All of the 3 cases in the group were turned to surgery;4)The relationship between endoscopic ultrasonography image characteristics and "cases of difficult opreation" : the shape of the circle and spindle is more common,but operation of irregular shape was more difficult,the boundary of them was fuzzy,and rotruding out of the cavity.There were a total of 29 cases concluded because of intraoperative blood loss,fifteen of them using the EUS detection blood flow,nine of them carefully operation avoiding excessive bleeding,three of them closing to the liver and choosing EFTR,with out intraoperatie liver injury.5)The relationship between pathological type and "cases of difficult operation" : the highest proportion was interstitialoma Then less proportion was schwannoma and heterotopic pancreas.6)The relationship between treatment mode and "cases of difficult operation" : when choosing STER operation for the intrinsic muscular layer of cardia,although the operation time was long,there was little bleeding and no perforated cases,no turned to surgery cases;The EFTR operation bleeding cases was less than ESD,and only 1 case turned to suigery for bleeding.In the group,the perforation rate of ESD was high.Conclusion:The technology of Photoshop combining with endoscopic ultrasonography can makes some difference of the diagnosis and differential diagnosis of gastric muscularis propria lesions,which can be used as a non-invasive and economic examination method,and has the potential value of clinical promotion.The gastric muscularis propria lesions 'characteristics for the endoscopic ultrasonography of the " cases of difficult operation " : irregular shape,unclear boundary,diameter greater than 3cm,and external growth;The operation of schwannoma and gastric heterotopic pancreas are difficult.The lesion at fundus of the stomach under 2cm is recommended to be treated with EFTR.The cardiac lesion can be considered to treat with STER.The gastric muscularis propria lesions with diameter of 2-3.5cm treated with EFTRwas more safe than ESD.