内镜超声和内镜黏膜下剥离诊治直肠类癌31例

Endoscopic Ultrasonography and Endoscopic Submucosal Dissection for the Diagnosis and Treatment of Rectal Carcinoid Tumors: Analysis on 31 Cases

目的探讨直肠类癌的内镜超声(endoscopic ultrasonography,EUS)特征及内镜黏膜下剥离(endoscopicsubmucosal dissection,ESD)治疗直肠类癌的安全性与可靠性。方法 2008年6月～2011年5月31例直肠类癌行EUS检查,对其中直径<1.5 cm的19例行ESD治疗。在瘤体边缘做环周标记,黏膜下注射甘油果糖和美蓝混合液,使瘤体与肌层分离,预切开瘤体周围黏膜,剥离瘤体下方黏膜下层组织,完整切除瘤体。结果通过EUS检查及深挖活检,诊断直肠类癌31例,EUS特征为位于黏膜下层或黏膜深层的边界清晰、内部回声欠均匀的低回声占位影。对19例直径<1.5 cm直肠类癌行ESD治疗,均完整切除瘤体。术中穿孔1例,术后出血1例,经内科保守治疗后痊愈。切除标本基底及边缘均无肿瘤组织残留。19例随访1～4年,平均1.8年,除1例因创面经久不愈转外科治疗外,其余均无复发及转移。结论 EUS可明确直肠类癌的来源层次、大小、内部回声、边界、有无肌层及周围血管浸润,指导治疗方案的选择。ESD治疗直径<1.0 cm的直肠类癌安全可靠,可避免不必要的手术。

Objective To assess the features of endoscopic uhrasonography （EUS）, and the safety and efficacy of endoscopic submucosal dissection （ESD） for rectal carcinoid tumors. Methods Between June 2008 and May 2011, 31 patients with rectal carcinoid tumors received EUS in our hospital, 19 of them showed a tumor smaller than 1.5 cm in diameter, and underwent ESD after the examination. After marking the surrounding mucosa of the phyma, we injected a mixture of glycerin fructose and methylene blue into the submucosa to elevate the phyma from the muscle layer; and then the surrounding mucosa of the phyma were pre-eut to dissect the connective tissue of the submucosa beneath the phyma, and then remove the tumor completely. Results EUS showed submucosal or deep mucosa hypoechoic masses with homogeneous echo and distinct border. The tumors smaller than 1.5 cm were all removed completely with ESD. Intraoperative perforation occurred in one patient, and postoperative hemorrhage was detected in one; both of the patients were cured with conservative therapies. No residual tumor tissues were detected after the operation. The 19 patients were followed up for 1 to 4 years with a mean of 1.8 years ; none of them had recurrence or metastasis, except for one patient, who was converted to open surgery because of non-healing surgical wound. Conclusions EUS can be used to determine surgical strategy for rectal carcinoid tumor for it provides precise information of the size, depth, border, muscularis propria or vessel infiltration of the tumor. For rectal carcinoid tumors smaller than 1.0 cm in diameter, ESD is safe and effective.