结直肠类癌内镜下诊断及治疗51例

目的:探讨结直肠类癌的内镜下诊断及治疗.方法:收集1986-04/2008-08我院经结肠镜检查并病理证实的类癌51例.分析其形态学特点、结肠镜下治疗及预后.结果:结直肠类癌男性明显多于女性(1.83:1),平均年龄53.0±13.2岁,直肠最多见(86.3%),最大径多小于1.0 cm(74.5%),内镜下多表现为典型的黏膜下肿物,色黄,质硬或韧,活动度差,≥2.0 cm多发生转移,≤1.0 cm者EMR法切除均无复发,6例术前行超声内镜检查,明确内镜下治疗的可能性.结论:掌握内镜下类癌的特点有助于提高肉眼诊断,深凿活检或EMR切除活检有助于提高诊断率,≤1.0 cm的类癌内镜下切除安全、有效.     

直肠类癌的内镜超声诊断和内镜黏膜下切除

目的 研究内镜超声对直肠类癌的诊断价值，探讨内镜下黏膜切除术治疗直肠类癌的应用价值。方法 应用微超声探头对结肠镜发现的黏膜正常的大肠隆起性病灶进行超声检查，对诊断直肠类癌病例应用套扎器对准病灶负压吸引进行圈套结扎，再在皮圈根部连皮圈电切病灶。比较内镜超声诊断和病理检查结果，观察切除标本基底有无肿瘤累及。结果 126例黏膜正常的大肠隆起性病灶经内镜超声诊断，25例直肠类癌全部得到病理证实。直肠类癌表现为黏膜下层的边界清晰、回声欠均匀的低回声肿块。全部类癌病例无固有肌层和血管浸润，行内镜黏膜下切除无一例出现出血和穿孔，切除标本边缘和基底无肿瘤累及。结论 内镜超声可以明确直肠类癌的肠壁来源、大小、内部回声性质、边界、有无肌层和周围血管浸润，内镜下黏膜切除术治疗直肠类癌疗效确切。     

内镜下黏膜切除术和内镜黏膜下剥离术治疗直肠类癌的对照研究

目的 评估内镜下黏膜切除术(EMR)和内镜黏膜下剥离术(ESD)治疗直肠类癌的有效性及安全性.方法 回顾性总结24例26处EMR治疗(EMR组)和19例20处ESD治疗(ESD组)的直肠类癌患者的临床资料,对比分析两组在病灶大小、手术时间、病灶整块切除率、组织病理学治愈性切除率、并发症及随访结果方面的差异.结果 ESD组术前超声内镜测量的直径大小为(7.4 ±5.3)mm,明显大于EMR组的(5.6 ±2.1)mm(P ＜0.05);ESD组手术时间为(32.6±10.5)min,明显长于EMR组的(8.9±6.3)min(P ＜0.05);EMR组和ESD组病灶均一次性完整切除,整块切除率均为100.0％;EMR组的组织病理学治愈性切除率为100.0％(26/26),略高于ESD组的95.0％ (19/20) (P＞0.05);EMR术后出血、穿孔并发症发生率为15.3％ (4/26),明显高于ESD组的5.0％ (1/20) (P＜0.05);两组在术后复查随访,均未发现局部复发.结论 对于直径小于7 mm的病灶应用EMR方法可以有效完整地切除病灶,并缩短手术时间;而对于直径大于7 mm和经过多次活检或局部切除后内镜下注射抬举征阴性的病灶,采取ESD的手术方式,方能得到比较满意的治疗效果.     

超声内镜对直肠类癌诊断及治疗的价值探讨

直肠类癌是起源于消化道APUD细胞系统的肿瘤,多发生于消化道的黏膜及黏膜下层,内镜检查通常表现为黏膜下肿物,与其他黏膜下肿物鉴别较为困难。而EUS的应用使对消化道黏膜下肿物的诊断水平有了较大提高。本文回顾性分析2006年3月-2008年10月我院应用EUS指导进行透明帽辅助的内镜黏膜下切除术（endoscopic submucosal resection using the cap,EsMRC）治疗的直肠类癌患者18例的临床资料,旨在探讨EUS指导直肠类癌诊断及治疗的价值。     

直肠类癌内镜黏膜下剥离治疗的临床研究

[目的]探讨超声内镜(endoscopic ultrasonography,EUS)诊断、内镜黏膜下剥离(endoscopic submucosal dissection,ESD)治疗直肠类癌的临床疗效及安全性。[方法]对经EUS证实并行ESD治疗的12例直肠类癌患者的临床资料进行回顾性分析。12例均在内镜下标识预切除范围、黏膜下多次注射、黏膜切开、病变剥离及创面钛夹处理。[结果]12例直肠类癌直径0.6~1.8cm,均一次性切除,病灶基底与周缘无类癌组织累及。随诊6~25个月无复发。[结论]经EUS证实行ESD治疗直径2cm,未浸及固有肌层、无远处转移的直肠类癌疗效确切、安全性好,适宜开展。     

直肠类癌的内镜下诊断与治疗

目的探讨直肠类癌的临床病理特点、诊断及治疗。方法对17例经内镜及病理学证实的直肠类癌病例进行回顾性分析,总结其临床表现、病理及治疗情况。结果直肠类癌多以腹痛、腹泻、大便性状改变为主要临床表现,免疫组化结果 CgA阳性率为53%,Syn阳性率为88%。所有患者经内镜下EMR或ESD治疗,无术中及术后迟发性出血发生。3例患者术后病理切缘可见肿瘤细胞,进一步追加外科手术治疗。结论直肠类癌主要通过内镜及病理学检查确诊,对于直径<1 cm的直肠类癌可采取内镜下切除治疗。     

内镜黏膜切除术治疗直肠类癌的价值评估

目的 探讨内镜下十二指肠乳头括约肌切开术（EST）治疗胆总管结石患者的远期治疗效果,评估EST术后胆囊切除的必要性.方法 对2006年1月至12月因胆总管结石而行EST治疗257例患者进行随访,所有患者平均随访时间为34.8个月（26～48个月）.根据不同病情和处理情况分为3组进行比较,合并有胆囊结石的患者EST术后行胆囊切除为A1组,EST术后未行胆囊切除为A2组;B组为未合并胆囊结石者.结果 出现远期并发症者31例（12.1%）,胆总管结石复发25例（9.7%）,胆管炎27例（10.1%）,胰腺炎2例（0.8%）,胆管癌1例（0.4%）;A2组患者远期并发症发生率、胆总管结石复发率均高于A1组（P均〈0.05）.结论 从远期疗效来看,EST是治疗胆总管结石的安全、有效的方法,对于合并有胆囊结石的患者EST术后行胆囊切除是有必要的.     

7例直肠类癌内镜诊治与随访

直肠类癌是一种特殊类型的消化道少见肿瘤,其组织结构似癌,但发展缓慢,又极少转移。1989年7月至2001年9月,我院经内镜检出产经病理证实7例直肠类癌,全部经内镜下高频电凝电切术治疗,术后随访1～12年,现报道如卜 1.临床资料:7例均为我院内镜常规检查病例,男4例,女3例,年龄26～60岁,平均42.2岁。临床表现为便次增多2例,排便不净感2例,便血1例,2例无临床症状     

直肠类癌的诊断及治疗现状

本文结合近年研究报道,总结直肠类癌的内镜下表现,评价超声内镜检查对肿瘤术前分期的价值及对术后预后的判断,介绍在直肠类癌分子生物学水平上的诊断进展,浅析不同直径直肠类癌的治疗原则,并比较不同内镜治疗方法的特点,以及影响直肠类癌5年生存率预后的相关因素。     

超声内镜结合内镜黏膜下剥离术对直肠类癌的临床疗效观察

[目的]探讨超声内镜(EUS)结合内镜黏膜下剥离术(ESD)治疗直肠类癌的效果及价值。[方法]对EUS检查发现来源于黏膜下层、无固有肌层受累、无淋巴结转移、直径≤1.5cm、考虑为直肠类癌的21例直肠黏膜隆起病灶行ESD治疗。ESD后6个月、12个月及24个月行EUS随访。[结果]21例均成功完成ESD,瘤体完整剥离,基底及边缘无残留;术中均无穿孔,术后创面少量出血5例,经内科治疗后痊愈;术后病检确诊为类癌,随访6~24个月,无一例病变残留和复发。[结论]EUS结合ESD治疗直径≤1.5cm、未侵犯固有肌层的直肠类癌安全有效,可避免不必要的外科手术。     

Endoloop ligation after endoscopic mucosal resection using a transparent cap: A novel method to treat small rectal carcinoid tumors

BACKGROUND Local endoscopic resection is an effective method for the treatment of small rectal carcinoid tumors, but remnant tumor at the margin after resection remains to be an issue.AIM To evaluate the efficacy and safety of resection of small rectal carcinoid tumors by endoloop ligation after cap-endoscopic mucosal resection(LC-EMR) using a transparent cap.METHODS Thirty-four patients with rectal carcinoid tumors of less than 10 mm in diameter were treated by LC-EMR(n = 22) or endoscopic submucosal dissection(ESD)(n =12) between January 2016 and December 2017. Demographic data, complete resection rates, pathologically complete resection rates, operation duration, and postoperative complications were collected. All cases were followed for 6 to 30 mo.RESULTS A total of 22 LC-EMR cases and 12 ESD cases were enrolled. The average age was48.18 ± 12.31 and 46.17 ± 12.57 years old, and the tumor size was 7.23 ± 1.63 mm and 7.50 ± 1.38 mm, respectively, for the LC-EMR and ESD groups. Resection time in the ESD group was longer than that in the LC-EMR group(15.67 ± 2.15 min vs 5.91 ± 0.87 min; P 0.001). All lesions were completely resected at one time. No perforation or delayed bleeding was observed in either group.Pathologically complete resection(P-CR) rate was 86.36%(19/22) and 91.67%(11/12) in the LC-EMR and ESD groups(P = 0.646), respectively. Two of the three cases with a positive margin in the LC-EMR group received transanal endoscopic microsurgery(TEM) and tumor cells were not identified in the postoperative specimens. The other case with a positive margin chose follow-up without further operation. One case with remnant tumor after ESD received further local ligation treatment. Neither local recurrence nor lymph node metastasis was found during the follow-up period.CONCLUSION LC-EMR appears to be an efficient and simple method for the treatment of small rectal carcinoid tumors, which can effectively avoid margin remnant tumors.     

胃类癌18例回顾性分析

目的　探讨胃类癌的内镜特点、病理学特点及内镜下治疗方法。方法　对 1990年 1月至 2 0 0 3年 4月确诊的 18例胃类癌患者临床资料进行分析。结果　 18例中典型类癌 5例 ,均表现为胃息肉样病变 ,胃多发息肉 (4～ 12个 )大小不等 ,直径 0 4～ 1 0cm ,表面黏膜欠光滑 ,呈桑葚状或结节状表面凸凹不平 ,可与炎性息肉或增生性息肉并存 ,活检及内镜下黏膜切除术后确诊 ,随访 5～ 35个月无复发。13例不典型类癌表现为溃疡浸润性肿物 ,多为形态不规则的单发大溃疡 ,直径 2cm以上 ,最大者 7cm× 8cm ,底部覆污秽苔 ,周边呈堤坝样隆起 ,与BorrmannⅢ型胃癌不易鉴别 ,经术后病理证实。结论　胃镜检查是胃类癌早期发现的重要手段 ,病理学及其免疫组织化学检查是确诊的方法 ,而内镜下黏膜切除术是微创治疗早期低度恶性胃类癌的首选。     

Endoscopic mucosal resection with a ligation device or endoscopic submucosal dissection for rectal carcinoid tumors: An analysis of 24 consecutive cases

Aims: Endoscopic submucosal dissection (ESD) has several advantages over conventional endoscopic mucosal resection, including a higher en bloc resection rate and more accurate pathological estimation. However, ESD is a complex procedure that requires advanced endoscopic skills. The aim of our study is to evaluate the efficacy of endoscopic mucosal resection with a ligation device (EMR‐L) compared to ESD for rectal carcinoid tumors. Methods: Between September 2003 and April 2011, 24 rectal carcinoid tumors in 24 patients treated by ESD or EMR‐L were retrospectively analyzed. The indications for endoscopic treatment were node‐negative rectal carcinoid tumors. We compared the therapeutic outcomes of the ESD group (n = 13) and the EMR‐L group (n = 11). Results: Both groups had similar mean tumor sizes (ESD: 5.5 ± 2.1 mm; EMR‐L: 4.4 ± 2.2 mm). The rates of en bloc and complete resection were, respectively, 100% and 92.3% for ESD, and 100% and 100% for EMR‐L. Perforations did not occur in either group. Postoperative bleeding occurred in one EMR‐L case, and it was endoscopically managed. However, there were no differences in therapeutic outcomes between the two groups. The mean procedure time was longer in the ESD group (28.8 ± 16.2 min) than in the EMR‐L group (17.4 ± 4.4 min), without a significant difference. The mean hospitalization period was significantly shorter in the EMR‐L group (1.8 ± 3.1 day) than in the ESD group (6.2 ± 2.1 day), and eight EMR‐L cases were treated in an outpatient setting. Conclusions: EMR‐L is a simple and effective procedure that compares favorably to ESD for small rectal carcinoid tumors.     

Endoscopic diagnosis and treatment of superficial nonampullary duodenal tumors

The diagnostic and treatment guidelines of superficial non-ampullary duodenal tumors have not been standardized due to their low prevalence.Previous reports suggested that a superficial adenocarcinoma(SAC) should be treated via local resection because of its low risk of lymph node metastasis,whereas a highgrade adenoma(HGA) should be resected because of its high risk of progression to adenocarcinoma.Therefore,pretreatment diagnosis of SAC or HGA is important to determine the appropriate treatment strategy.There are certain endoscopic features known to be associated with SAC or HGA,and current practice prioritizes the endoscopic and biopsy diagnosis of these conditions.Surgical treatment of these duodenal lesions is often related to high risk of morbidity,and therefore endoscopic resection has become increasingly common in recent years.Endoscopic mucosal resection(EMR) and endoscopic submucosal dissection(ESD) are the commonly performed endoscopic resection methods.EMR is preferred due to its lower risk of adverse events;however,it has a higher risk of recurrence than ESD.Recently,a new and safer endoscopic procedure that reduces adverse events from EMR or ESD has been reported.     

Endoscopic treatment and management of rectal neuroendocrine tumors less than 10 mm in diameter

Rectal neuroendocrine tumors (rNETs) measuring less than 10 mm in diameter are defined as small rNETs. Due to the low risk of distant invasion and metastasis, endoscopic treatments, including modified endoscopic mucosal resection, endoscopic submucosal dissection, and other transanal surgical procedures, are effective. This review article proposes a follow-up plan according to the size and histopathology of the tumor after operation.     

Treatment outcomes of endoscopic resection for rectal carcinoid tumors: an analysis of the resectability and long-term results from 46 consecutive cases

Aim: In Japan, most of colorectal carcinoid tumors developed in rectum. The choice of treatment is important because surgical treatment may need to construct artificial anus. Although curative endoscopic resection (ER) is desirable from the point of quality of life, sufficient evidence of endoscopic treatment for rectal carcinoid tumors is not fully obtained.

Methods: Between April 2001 and August 2013, 46 rectal carcinoid tumors in 46 patients who underwent either with endoscopic mucosal resection with a ligation device (EMR-L) or endoscopic submucosal dissection (ESD) were analyzed retrospectively. The rates of en bloc resection, positive for lateral and/or vertical margin, curative resection, local recurrence, additional treatments, overall and disease-specific survival rate after ER were evaluated during follow-up (median observation period 61.6 months).

Results: Twenty-two lesions were treated by EMR-L and 24 lesions were treated by ESD. Both groups had similar mean tumor size (EMR-L: 6.2?mm, ESD: 6.0?mm). The rate of en bloc resection, negative for both lateral and vertical margins, and curative resection were, respectively, 73%, 63%, and 50% for EMR-L, 100%, 100%, and 83% for ESD. These results suggested that the rate of resectability and curability for ESD was significantly higher than EMR-L (p?Conclusion: The long-term outcomes of ER for rectal carcinoid tumors were excellent. ESD has advantage for resectability and curability compared with EMR-L; therefore, ESD is more favorable procedure as treatment for rectal carcinoid tumors.