| Objective:Through retrospective studies,to analyze the value of endoscopic ultrasonography(EUS)in the diagnosis and differential diagnosis of upper gastrointestinal submucosal tumors(SMT);To analyze the value and safety of endoscopic ultrasonography in guiding the treatment of upper gastrointestinal submucosal tumor resection.Methods:This study collected patients with upper gastrointestinal submucosal tumors diagnosed by endoscopic ultrasonography at the digestive endoscopy center of the Second People’s Hospital of Gansu from 2016.01 to 2019.06,and study the ultrasonic characteristics,origin and size of upper gastrointestinal submucosal tumors and make a preliminary diagnosis.Different treatment methods were selected according to the diagnosis,lesion size and origin of EUS.Using postoperative pathology as the gold standard,the diagnostic value of endoscopic ultrasonography in submucosal tumors was evaluated.By analyzing the completeness of the lesion resection and postoperative complications,the guiding value,safety and effectiveness of ultrasound endoscope in the treatment of submucosal tumors of the upper gastrointestinal tract are explored.Results:1.A total of 155 submucosal tumors were included,58 in the esophagus,89 in the stomach,and 8 in the duodenum.The tumor size ranged from 0.31 to 6.00 cm.2.Ultrasound endoscopy diagnosed 69 cases of leiomyoma,67 cases of low echo,and 2 cases of high echo,the echo was basically uniform,mainly from the mucosal muscle layer;63 cases of stromal tumors,with 17 cases of low echo、36 cases of mixed echo and 10 cases of hyperechoic,the echo may be uneven,mainly originated from the inherent muscular layer;6 cases of diagnosis of cysts are located in the submucosa,showing an echoless structure;14 cases of lipoma are located in the submucosa,which is hyperechoicmanifestation,and posterior echo attenuation can be seen;3 cases of ectopic pancreas showed uneven medium and high echoes,with occasional umbilical-like structures visible.After surgical resection,57 cases of stromal tumor,68 cases of leiomyoma,2 cases of neuroendocrine tumor,10 cases of lipoma,1 case of hemangioma,9 cases of cyst,6 cases of ectopic pancreas,and 2 cases of lymphoid tissue hyperplasia were clearly diagnosed by pathology.The accuracy rate of endoscopic ultrasonography for qualitative diagnosis of submucosal tumors in the upper gastrointestinal tract was 86.25%(134/155),with good postoperative pathological consistency(kappa = 0.624).3.Ultrasound endoscopy predicts that 64 cases of submucosal tumors are located in the muscularis mucosa,26 cases in the submucosa,and 65 cases in the lamina propria.There are 145 cases with the same level of disease origin as found in the endoscopic surgery,61 cases in the mucosal muscle layer,In 25 cases of the submucosa and 59 cases of the muscularis propria,the accuracy of ultrasonographic endoscopic diagnosis of the source of lesions was 93.54%(145/155),and the postoperative consistency was excellent(kappa = 0.897).4.Postoperative pathological diagnosis of 68 cases of leiomyoma and 57 cases of stromal tumors,leiomyomas were mostly located in the esophagus in 48 cases(70.58%),54 cases of stromal tumors(94.74%)were more common in the stomach,and the stromal tumors average body diameter was 2.21±1.17 cm,which was derived from 41 cases(71.93%)of the extrinsic muscularis,32 cases of uneven echo(56.14%),4 cases of internal calcification(7.02%),and 18 cases of hypoecho(31.58%).Compared with leiomyoma(Tumor diameter,source level,echo uniformity,internal calcification,echo intensity),the differences were significant(P <0.05).5.Choose different treatment methods according to the origin of the lesion,142 cases of SMT underwent simple endoscopic resection,80 cases of EMR resection,11 cases of ESD,7 cases of STER,33 cases of ESE and 11 cases of EFR,there were significant differences in tumor size and source level among the five groups(P < 0.05).There were no cases of delayed bleeding and severe infection in each group under endoscopic treatment.In the ESD group,1 case(0.7%)suffered major bleeding during the operation.In addition to EFR active perforation,a total of 3 cases experienced passive perforation(2.11%),Which were 2 cases in the STER group and 1 case in the ESE group.The incidence of complications among the 5 groups was different(P <0.05).The one-time complete resection rate of EMR was 96.25%,the ESE was 93.94%,and the rest were 100% complete resection.There was no significant difference in one-time complete resection rate(P> 0.05).Conclusion:Endoscopic ultrasound can clearly show the characteristics of the upper gastrointestinal submucosal tumor and its relationship with surrounding tissues,determine the size,source level,and nature of the tumor with high accuracy.At the same time to guide the choice of operation method of submucosal tumor,endoscopic submucosal tumor resection is safe and effective,has clinical practical value. |
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