内镜黏膜下剥离术治疗直肠类癌17例

Endoscopic submucosal dissection for rectal carcinoid tumors: An analysis of 17 cases

目的:探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗直肠类癌的应用价值.方法:对内镜发现的直肠黏膜下肿瘤,通过微超声探头检查,超声内镜明确诊断17例来源于黏膜下层、没有固有肌层受累和淋巴结或远处转移的直肠类癌,用Dual Knife和IT-2 Knife进行ESD治疗,并进行术后随访.结果:17例成功完成ESD治疗,完整切除率达100%.病变最大直径0.4-1.2 cm(平均0.72 cm),手术时间7-25 min(平均9.4 min).无1例出现迟发性出血及穿孔.所有ESD剥离肿瘤包膜完整,基底和切缘0.2 cm以内均未见病变累及.术后随访3-36 mo,无1例病变残留和复发.结论:ESD治疗直径≤2.0 cm、未侵犯固有肌层的直肠类癌安全、有效,可以一次性完整切除病变,提供完整的病理学诊断资料.

AIM： To assess the clinical efficacy and safety of endoscopic submucosal dissection （ESD） for rectal carcinoid tumors. METHODS： Seventeen consecutive patients with 17 carcinoid tumors were enrolled. Carcinoid tumors were diagnosed by colonoscopy and endo-scopic ultrasonography, and further confirmed by histopathologic examination of resected specimens. There was no endoscopic evidence of muscularis propria invasion or evidence of lymph node or distant metastasis. Tumors were resected by ESD with the Dual Knife and IT-2 Knife. All cases were followed after operation. RESULTS： Complete resection was achieved in all 17 cases （100%）. The size of tumors ranged from 0.4 to 1.2 cm （average 0.72 cm）. The opera- tive time was 7-25 min （average 9.4 min）. No late hemorrhage or perforation occurred. The capsules of all resected tumors were complete. The bases of tumors and the edges within 0.2 cm from tumors had no lesions. No residual lesion or recurrence occurred during the follow-up period of 3-36 mo. CONCLUSION： ESD is feasible and effective for patients with a rectal carcinoid tumor smaller than 10, but without muscularis propria invasion.