微探头超声引导下行ESD治疗直肠类癌有效性和安全性评价

The efficacy and safety assessment of ESD under the guidance of Micro-probe ultrasound in the treatment of rectal carcinoid tumor

目的评价微探头超声内镜（MPS）引导下行内镜下黏膜剥离术（ESD）治疗直肠类癌的有效性和安全性。方法分析我院2014年1月至2015年12月间经MPS初步诊断直肠类癌,行ESD治疗并有病理证实的13例病例（14处病变）,其中男9例,女4例,平均年龄47岁（范围28~60岁）,分析其内镜形态学特点、ESD治疗及预后。结果 13例患者MPS主要表现为起源于黏膜下层未侵及肌层欠均匀低回声影像,直径均〈1 cm。ESD完整切除所有病变,病理结果显示ESD水平及垂直切缘均为阴性,术中均无出血及穿孔等并发症;与ESD术后病理诊断相比,MPS对直肠类癌诊断符合率为78.5%,对病变深度诊断准确性为100%,MPS测量病变大小较病理测量结果大（P〈0.05）;术后随访2~15月均无残留或复发。结论 MPS对直肠类癌具有较高诊断精度,可作为指导直肠类癌治疗必要程序,对病变大小〈1 cm的直肠类癌患者,经MPS引导下行ESD治疗是有效、安全和适宜的。

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection（ESD）guided by Micro-probe ultrasound（MPS） in the treatment of rectal carcinoid tumors.Methods In this study,14 rectal carcinoid tumors in 13 patients were preliminary diagnosed by MPS and pathological confirmed and treated by ESD during January 2014 to December 2015 in our hospital.Including 10 male patients,and four female cases,average age was 47 years old（range,28-60 years old）,analysis of the characteristics of endoscopic morphology,ESD treatment and prognosis.Results MPS characteristics of the13 patients were mainly inhomogeneous low echo-level image originated from strata submucosum but without invading the muscular,diameter was less than 1cm.ESD complete resection of all lesions,pathological results showed that the ESD resection margins were negative,there were no intra-operative complications such as bleeding and perforation.Compared with the pathological diagnosis,MPS rectal carcinoid diagnosis accordance rate was 78.5%,the diagnostic accuracy of depth of the lesion was 100%,MPS measurement of lesion size was larger than pathological measurement results（P〈0.05）.There was no residual or recurrence followed up for 2 to 15 months after operation.Conclusions Endoscopic submucosal dissection and preoperative assessment with MPS is effective,safe and appropriate for treating rectal carcinoid tumors with lesion size less than 1cm.