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山东大学学报（医学版） ›› 2014, Vol. 52 ›› Issue (12): 78-82.doi: 10.6040/j.issn.1671-7554.0.2014.282

• 临床医学 • 上一篇    下一篇

上消化道黏膜下病变套扎治疗的远期效果及其影响因素

刘风燕, 韩冰, 钟宁, 郑雪婷, 李文捷, 韩炜, 贾晓青, 李延青   

  1. 山东大学齐鲁医院消化内科, 山东 济南 250012
  • 收稿日期:2014-05-04 修回日期:2014-11-24 发布日期:2014-12-10
  • 通讯作者: 钟宁。E-mail:Nathan.zhongning@foxmail.com E-mail:Nathan.zhongning@foxmail.com
  • 基金资助:
    山东省医药卫生科技发展计划(2013WS0235)

Endoscopic band ligation of upper gastrointestinal submucosal lesions: long-term outcomes and risk factors

LIU Fengyan, HAN Bing, ZHONG Ning, ZHENG Xueting, LI Wenjie, HAN Wei, JIA Xiaoqing, LI Yanqing   

  1. Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
  • Received:2014-05-04 Revised:2014-11-24 Published:2014-12-10

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摘要： 目的 探讨经内镜下套扎治疗上消化道黏膜下病变的远期疗效和安全性,以及影响其治疗效果的影响因素。方法 回顾性分析上消化道黏膜下病变橡皮环套扎治疗病例194例。通过远期随访获得治疗成功率,分析影响疗效的临床和内镜因素。以超声内镜结果为最终标准,分析普通内镜评估深浅层次的准确性。结果 194例中,套扎治疗完成184例,随访成功122例,通过内镜复查,套扎治疗成功率为90%。通过对比分析患者的一般情况及超声内镜影像特点,发现病变长径超过0.8 cm和所处深部层次是降低套扎治疗长期成功率的最重要影响因素。平片内镜对层次的评估与超声内镜对层次的评估不一致(Kappa值为0.04)。结论 内镜下套扎术是治疗上消化道黏膜下病变安全有效的技术,但术后随访对疗效评估是必不可少的,超声内镜是术前评估是否适合该治疗方式的重要手段。

关键词: 套扎治疗, 上消化道, 平片内镜, 超声内镜, 黏膜下病变

Abstract: Objective To evaluate the long-term outcomes after endoscopic band ligation of upper gastrointestinal submucosal lesions and risk factors. Methods Clinical and endoscopic data of 194 cases of upper gastrointestinal submucosal lesions undertaking endoscopic band ligation were retrospectively analyzed. The success rate of treatment and adverse effect were obtained during long-term follow-up. The accrate rate of common endoscopy in evaluating the depth of lesions was assessed according to endoscopic ultrasound reports. Results The ligation was accomplished in 184 cases (94.8%), 90% of which were successful. Multivariable analysis showed that lesion diameter of more than 0.8cm and deep location were risk factors for the failure of ligation procedure. Evaluation of the depth of lesions by common white light endoscopy and endoscopic ultrasound was not comparable (Kappa value 0.04). Conclusion Endoscopic ligation of submucosal lesions in upper digestive tract is safe and effective, yet follow-up is necessary even for those who were thought to achieve success by the operators. And endoscopic ultrasound evaluation is essential before the procedure.

Key words: Upper gastrointestinal tract, Submucosal lesions, Flat sheet endoscopy, Endoscopic ultrasound, Band ligation

中图分类号: 

  • R571
[1] Papanikolaou I S, Triantafyllou K, Kourikou A, et al. Endoscopic ultrasonography for gastric submucosal lesions[J]. World J Gastrointest Endosc, 2011, 3(5): 86-94.
[2] Yu J P, H S Luo, X Z Wang. Endoscopic treatment of submucosal lesions of the gastrointestinal tract[J]. Endoscopy, 1992, 24(3): 190-193.
[3] Ponsaing L G, Kiss K, Hansen M B. Classification of submucosal tumors in the gastrointestinal tract[J]. World J Gastroenterol, 2007, 13(24): 3311-3315.
[4] Chang K J, Yoshinaka R, Nguyen P. Endoscopic ultrasound-assisted band ligation: a new technique for resection of submucosal tumors[J]. Gastrointest Endosc, 1996,44(6): 720-722.
[5] Suzuki S, Ishii N, Uemura M, et al. Endoscopic submucosal dissection (ESD) for gastrointestinal carcinoid tumors[J]. Surg Endosc, 2012, 26(3): 759-763.
[6] 王学群,陈海昕, 陈斌, 等. 内镜下橡皮圈套扎术治疗上消化道黏膜下肿瘤疗效观察——附46例报告[J]. 新医学, 2010, 41(8): 501-502, 560. WANG Xuequn, CHEN Haixin, CHEN Bin, et al. Efficiency of endoscopic ligation in treating upper gastrointestinal submucosal tumors[J]. New Medicine, 2010, 41(8): 501-502, 560.
[7] 何池义, 韩真, 李芳芳, 等. 内镜超声检查在上消化道黏膜下肿瘤微创治疗中的价值研究[J]. 中华消化内镜杂志, 2010, 27(3): 134-137. HE Chiyi, HAN Zhen, LI Fangfang, et al. Value of endoscopic ultrasonography in choice of endoscopic therapy strategies for submucosal tumors in upper gastrointestinal tract[J]. Chinese Journal of Degestive Endoscopy, 2010, 27(3): 134-137.
[8] Sun S, Ge N, Wang C, et al. Endoscopic band ligation of small gastric stromal tumors and follow-up by endoscopic ultrasonography[J]. Surgical Endoscopy, 2006, 21(4): 574-578.
[9] Huang W H, Feng C L, Lai H C, et al. Endoscopic ligation and resection for the treatment of small EUS-suspected gastric GI stromal tumors[J]. Gastrointest Endosc, 2010, 71(6): 1076-1081.
[10] Bai J, Wang Y, Guo H, et al. Endoscopic resection of small gastrointestinal stromal tumors[J]. Dig Dis Sci, 2010, 55(7): 1950-1954.
[11] Hirota W K, Zuckerman M J, Adler D G, et al. ASGE guideline: The role of endoscopy in the surveillance of premalignant conditions of the upper GI tract[J]. Gastrointestinal Endoscopy, 2006, 63(4): 570-580.
[12] Laurini J A, Carter J E. Gastrointestinal stromal tumors: a review of the literature[J]. Arch Pathol Lab Med, 2010,134(1): 134-141.
[13] Huang R, Xiang P. Current status of diagnosis and management of gastrointestinal stromal tumors[J]. Chinese Journal of Gastroenterology, 2013, 18(7): 440-443.
[14] Faigel D O, Abulhawa S. Gastrointestinal stromal tumors: the role of the gastroenterologist in diagnosis and risk stratification[J]. J Clin Gastroenterol, 2012, 46(8): 629-636.
[15] Sun S, Ge N, Wang C, et al. Endoscopic band ligation of small gastric stromal tumors and follow-up by endoscopic ultrasonography[J]. Surg Endosc, 2007, 21(4):574-578.
[16] Sun S, Jin Y, Chang G, et al. Endoscopic band ligation without electrosurgery: a new technique for excision of small upper-GI leiomyoma[J]. Gastrointest Endosc, 2004, 60(2): 218-222.
[17] Sun S, Ge N, Wang S, et al. EUS-assisted band ligation of small duodenal stromal tumors and follow-up by EUS[J]. Gastrointest Endosc, 2009, 69(3 Pt 1): 492-496.
[18] Saftoiu A, Vilmann P, Ciurea T. Utility of endoscopic ultrasound for the diagnosis and treatment of submucosal tumors of the upper gastrointestinal tract[J]. Rom J Gastroenterol, 2003, 12(3): 215-219.
[19] Ponsaing L G, Kiss K, Loft A, et al. Diagnostic procedures for submucosal tumors in the gastrointestinal tract[J]. World J Gastroenterol, 2007, 13(24): 3301-3310.
[20] Enestvedt B K, Chandrasekhara V, Ginsberg G G. Endoscopic ultrasonographic assessment of gastric polyps and endoscopic mucosal resection[J]. Current Gastroenterology Reports, 2012, 14(6):497-503.
[21] Wang L, Chen S Y, Huang Y, et al. Selective endoscopic ligation for treatment of upper gastrointestinal protuberant lesions[J]. World J Gastroenterol, 2013, 19(33):5581-5585.
[22] Suzuki T, Arai M, Matsumura T, et al. Factors Associated with Inadequate Tissue Yield in EUS-FNA for Gastric SMT[J]. ISRN Gastroenterol, 2011, 2011:619128. doi: 10.5402/2011/619128.
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