直肠类癌33例内镜治疗体会及文献回顾

目的总结直肠类癌的内镜下治疗方法与各自的优势。方法对2009年1月至2012年12月33例直肠类癌行内镜下治疗患者的临床资料进行回顾性分析,所有患者根据情况分别选择内镜下黏膜切除术（EMR）或经内镜黏膜下剥离术（ESD）治疗,总结其内镜下表现特点及治疗情况。结果 33例直肠类癌中,14例行EMR治疗,19例行ESD治疗。病灶位于直肠距肛门齿状线4～15cm,切除病灶直径0.3～1.5 cm。7例行EMR中途改行ESD,2例EMR术后肿瘤残留追加外科手术。病理学分析ESD组完整切除率（100%）较EMR组完整切除率（85.7%）有所提高,但差异无统计学意义（P〉0.05）。两组均未出现大出血、穿孔等并发症。结论相比EMR,ESD可能有利于实现直肠类癌病变的完整切除,减少复发,且安全性不亚于EMR。对于较小的直肠类癌,ESD不失为一种有效的治疗手段。

Endoscopic therapy of 33 patients with rectal carcinoid tumors and literature review

Objective To summarize various endoscopic therapy techniques for rectal carcinoid tumors and their respective advantage. Methods Retrospective analysis was made for 33 rectal carcinoid cases with endoscopic therapy between January 2009 and December 2012. Based on the conditions, the patients underwent endoscopic mucosal resection （EMR） or endoscopic submucosal dissection （ESD）, respectively. Endoscopic manifestation and treatment were summarized, and the related literatures were reviewed. Results Of 33 cases, 14 underwent EMR, and 19 underwent ESD. All the lesions located in a distance of 4 - 15cm from the anus dentate line to the rectum. The diameters of removed lesions were 0.3 - 1.5cm. Seven cases performed EMR were changed to performing ESD during operation. Two cases underwent an additional surgical operation after EMR because of tumor residue. The pathological complete resection rate in the ESD was 100% , and in the EMR was 85.7% , it seems that the former was high than the latter, but there was no statistical difference （ P 〉 0.05 ）. No complications such as massive hemorrhage and perforation occurred in two groups. Conclusions Compared with EMR, ESD might be in favor of complete excision for the lesions of carcinoids, decrease recurrence and have the safety no less than EMR. ESD can yet be regarded as an effective treatment for smaller rectal carcinoid tumors.