联合超声内镜行内镜下切除治疗消化道类癌的临床分析

Clinical Analysis of Endoscopic Ultrasonography Combined With Endoscopy for Gastrointestinal Carcinoid

目的：探讨联合超声内镜（EUS）行内镜下切除〔内镜下黏膜切除术（ EMR）、内镜黏膜下剥离术（ESD）〕治疗消化道类癌的安全性与可靠性。方法对宜昌市中心人民医院消化内镜室2004年3月—2011年8月行常规检查时发现消化道黏膜面呈半球状隆起的患者18例，患者常规内镜检查考虑消化道类癌后均行 EUS 检查，对其中直径〈1 cm 的行 EMR 治疗，直径1~2 cm 的行 ESD 治疗。结果18例患者 EUS 所见考虑肿瘤可能，未累及肌层，其中17例病灶深度判断正确。病灶部位为直肠11例，胃3例，食管2例，十二指肠球部2例；18例患者均成功完成内镜下切除治疗，17例切除完整，1例病变与肌层有粘连，转手术治疗。术后随访患者均未发现肿瘤复发及转移。结论联合 EUS 行内镜下切除治疗直径≤2 cm 且未累及肌层的消化道类癌安全可靠。

Objectjve To investigate the safety and reliability of endoscopic ultrasonography（ EUS）,endoscopic mucosa resection（EMR）and endoscopic submucosal dissection（ESD）for patients with gastrointestinal carcinoid. Methods A total of 18 patients confirmed with gastrointestinal carcinoid in Gastrointestinal Endoscopy Room of Yichang Central People′s Hospital from March 2004 to August 2011 were selected,and patients who showed hemispherical hump on the mucosa surface of the digestive tract were analyzed retrospectively. EUS was performed when the gastrointestinal carcinoid was suspected after endoscopy. EMR was performed when the diameter of the lesions were less than 1 cm,and ESD was performed when the diameter of the lesions were from 1 cm to 2 cm. Results Eighteen cases were suspected of carcinoid without muscular layer involvement, and 17 patients were diagnosed accurately in terms of the depth of lesion. The lesions were located in rectum（11 cases）, stomach（3 cases）,esophagus（2 cases）and duodenal bulb（2 cases）. All the 18 cases were given endoscopic therapy successfully,with 17 cases having complete resection. One case was converted to surgery due to adhesion of lesion and muscularis. No recurrent carcinoid or metastasis occurred during the follow - up. Conclusjon The EUS examination and endoscopic resection is feasible and reliable for patients with gastrointestinal carcinoid less than 2 cm in diameter without muscular layer involvement.