超声内镜引导深挖活检联合黏膜切除术诊治早期直肠类癌

目的 探讨超声内镜引导下深挖活检早期诊断直肠类癌以及内镜下黏膜切除术治疗直肠类癌的安全性、有效性。方法在超声内镜引导下深挖活检、结合病理及免疫组化检查,诊断直肠类癌24例。对24例直肠类癌的内镜及超声影像特点进行回顾性分析,总结其特征。对病灶直径小于1．5cm、浸润深度不超过黏膜下层、无肝转移及腹水发生的直肠类癌采取内镜下黏膜切除术治疗。结果24例直肠类癌分别距离肛缘5cm～12cm,病灶大小0．8cm～1．5cm,术后切除的标本切缘完整,基底无残留,治疗过程中均未发生穿孔,无迟发性出血,术后创面即刻渗血1例,经内镜治疗血止。随访3至5年无转移及再发。结论直肠类癌可通过超声内镜引导下深挖活检,钳取组织行病理及免疫组化检查而确诊,内镜下黏膜切除术治疗直径小于1．5cm的直肠类癌简单、安全有效。     

直肠类癌的内镜超声图像特征

目的探讨直肠类癌的内镜超声(EUS)图像特征，以提高其诊断正确率。方法连续收集2001年4月至2004年4月直肠黏膜及黏膜下肿物29例，行EUS检查及病理检查，分析经病理确诊的直肠类癌的EUS图像，找出其特征性表现。结果29例共检出病灶29个，其中类癌12个，腺瘤11个，炎性病灶6个。直肠类癌病灶中10个呈低回声结节，2个呈等回声；5个病灶位于黏膜层，7个位于黏膜下层；12个病灶边界均清晰。结论直肠类癌的EUS声像图特征是：病灶边界清，回声均匀，位于黏膜下层或黏膜层，绝大多数呈低回声结节。EUS声像图特征有助于直肠类癌的早期诊断。     

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。     

经肠镜微探头超声检查对结直肠黏膜下隆起病灶的诊断分析

目的 探讨经内镜微探头超声检查对结直肠黏膜下隆起病灶的诊断价值.方法 应用微探头对68例70处结直肠黏膜下隆起性病灶进行肠镜下超声检查,总结内镜超声特点,并与最终诊断比较.结果 发现类癌20例,表现为黏膜下层低回声;脂肪瘤12例,多位于右半结肠(11/12),表现为黏膜下层、边界清楚的强回声;囊肿12例,表现为黏膜下层的单房或多房性的无回声区,包膜完整;间质瘤或平滑肌瘤12例,多位于直肠9例,表现为黏膜肌层及以下各层次的均匀或不均匀低回声为主,外覆稍强回声包膜,两者在超声下很难区别;恶性淋巴瘤3例5个,表现为局部黏膜肌层和黏膜下层增厚,呈中低回声,不均匀,较少侵及固有肌层;血管性病变(血管瘤、静脉曲张)3个,表现为黏膜及黏膜下层的无回声,部分中、高回声,圆形或不规则形,散在或成族状分布,部分互相沟通;另外,还有子宫内膜异位2例,色素沉积1例,阑尾慢性脓肿1例,壁外压迫2例.超声与最终诊断结果均相符.结论 经内镜微探头超声检查可以明确大肠黏膜下隆起的大小、肠壁起源和边界.根据超声特征对黏膜下良恶性判别有一定的价值,同时能与腔外压迫性病变相鉴别.     

胃肠道类癌的内镜下诊断与治疗

目的探讨内镜在胃肠道类癌诊断治疗中的作用。方法对44例病理确诊的胃肠类癌患者的内镜下诊断及治疗等资料进行回顾分析,总结其内镜下表现特点、治疗情况及随访结果。结果类癌患者常因腹痛和排便习惯改变就诊发现,部分为无症状查体发现。胃肠类癌多为黏膜下隆起病灶,PitⅠ型;大的肿物可表现为息肉样,Pit Ⅲ型;少数为恶性类癌,Pit Ⅴ型。29例行超声内镜检查,超声内镜下表现为低回声或低回声为主病变,边界清。内镜下高频电凝切除术治疗12例,内镜下黏膜切除术治疗32例。除1例恶性类癌诊断半年后全身转移死亡外,余43例内镜下切除治疗后随访3个月至5年无1例复发。结论胃肠类癌缺乏特异临床表现,内镜下可对胃肠道类癌进行诊断和治疗。     

食管早期癌和癌前病变超声内镜诊断及内镜下食管黏膜切除术的临床研究

目的探讨食管早期癌和癌前病变超声内镜诊断价值及内镜下食管黏膜切除术的临床治疗价值。方法 61例食管早期癌和癌前病变行超声内镜检查探测病变浸润深度,位于黏膜层及黏膜肌层的食管早期癌和癌前病变行内镜下食管黏膜切除术（EMR）,位于黏膜下层的食管早期癌行外科手术治疗。EMR术28例,外科手术33例。比较超声内镜和术后病理判断病变浸润深度。结果超声内镜判断食管黏膜内癌的特异性和敏感性为94.1%（48/51）、98.0%（48/49）;黏膜下癌的特异性和敏感性为80.0%（8/10）、72.7%（8/11）;鉴别黏膜内癌及黏膜下癌浸润深度准确率为91.8%（56/61）。28例EMR术后病理：14例食管早期癌和12例食管黏膜中重度异型增生完全切除,完全切除成功率为92.9%（26/28）,观察3～45个月无复发。结论超声内镜能较准确鉴别食管早期癌和癌前病变浸润深度,黏膜切除术治疗食管早期癌和癌前病变是安全有效的内镜治疗方法。     

超声内镜对胃异位胰腺的诊断及治疗价值

目的 探讨超声内镜(EUS)对胃异位胰腺的诊断及治疗价值.方法 收集本院2009年3月至2011年8月经普通胃镜及超声内镜检出的32例胃异位胰腺患者,分析异位胰腺的EUS图像特征,对其行内镜下皮圈套扎联合高频电切除术,评价其疗效.结果 胃异位胰腺在EUS下表现为隆起型病变,可发生于胃壁超声结构任何一层或多层,以黏膜下层多见,呈低、中或混合回声.其中22例行皮圈套扎后高频电切除,无明显并发症,17例内镜复查无复发.2例行内镜下黏膜切除术(EMR),1例行黏膜剥离术(ESD),7例未予处理.结论 EUS对异位胰腺有重要的诊断价值,内镜下皮圈套扎后高频电切除治疗简单、经济、安全、有效,值得临床推广.     

内镜黏膜切除术治疗大肠广基大息肉

目的探讨内镜黏膜切除术(EMR)对肠道广基大息肉样病变的治疗价值。方法采用结肠镜下大肠黏膜切除术治疗135例共157个结直肠广基大息肉。病灶黏膜下注射肾上腺素生理盐水后,一次圈套整块切除或分次圈套切除病变,回收全部标本送病理检查,术后结肠镜随访。结果全部息肉EMR一次切除,除3个位于直肠黏膜下的病灶小于1 cm外,其余均大于1.5 cm,最大的13 cm×12 cm,无手术并发症。术后病理:腺瘤123个,其中有异型增生80个;黏膜内癌11个;增生性息肉20个;直肠类癌3个。随访中,有2例大于7 cm的直肠腺瘤分别于术后1个月及3个月复查时复发,均给予热活检钳完整钳除,病理分别为增生性息肉和绒毛状腺瘤,再复查6-12个月无复发。结论EMR是治疗大肠癌前病变及黏膜内癌安全、有效的方法。     

内镜超声检查在上消化道黏膜下肿瘤微创治疗中的价值研究

目的评价超声内镜检查对上消化道黏膜下肿瘤的诊断价值及指导内镜下微创治疗黏膜下肿瘤的疗效及安全性。方法经超声内镜诊断上消化道黏膜下肿瘤82例,根据黏膜下肿瘤的起源层次、大小及性质分别选择不同的内镜治疗方案,内镜治疗包括高频电凝电切术、内镜下黏膜切除术、皮圈套扎术等。标本行常规病理学及免疫组化检查。术后定期内镜随访。结果26例超声判断起源于黏膜肌层的上消化道黏膜下肿瘤行高频电凝电切术;17例起源于黏膜肌层的平坦型上消化道黏膜下肿瘤行内镜下黏膜切除术;38例起源于固有肌层和1例起源于黏膜肌层的上消化道黏膜下肿瘤行皮圈套扎术。内镜超声诊断与术后病理符合率为91．4％。术后1例出血,其余无严重并发症发生。79例术后随访3—24个月无复发。结论超声内镜能够对消化道黏膜下肿瘤进行起源和定性诊断,超声内镜为内镜微创治疗选择消化道黏膜下肿瘤适应证具有良好的指导作用,内镜治疗是消化道黏膜下肿瘤治疗的安全、有效的手段。     

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。     

内镜超声在消化道黏膜下肿瘤诊断与治疗中的价值

目的 评价内镜超声在消化道黏膜下肿瘤的诊断及治疗中的价值.方法 对内镜检查中怀疑黏膜下肿瘤者进行内镜超声检查,根据黏膜下肿瘤的起源层次及性质决定治疗方案,内镜治疗包括内镜下黏膜切除术、黏膜剥离-肿瘤摘除术、高频电切术及硬化治疗.结果 73例良性间质瘤起源于黏膜肌层,7例直肠类癌位于黏膜固有层;脂肪瘤13例、异位胰腺17例、胃底静脉曲张5例、囊肿6例起源于黏膜下层;95例良性间质瘤及21例恶性间质瘤起源于固有肌层,1例类癌侵及固有肌层.61例源于黏膜肌层及8例源于固有肌层的良性间质瘤、8例脂肪瘤、8例异位胰腺及7例类癌经内镜切除,4例囊肿行内镜下穿刺治疗;33例源于固有肌层的良性间质瘤、18例恶性间质瘤、2例脂肪瘤、2例异位胰腺及1例类癌经手术切除.病理符合率为97.97%.结论 超声内镜能够对消化道黏膜下肿瘤进行起源和定性诊断,对黏膜下肿瘤治疗方案的选择具有重要的指导意义.     

Endoscopic mucosal resection for rectal carcinoids under micro-probe ultrasound guidance

AIM: To assess the therapeutic value of endoscopic mucosal resection (EMR) under micro-probe ultrasound guidance for rectal carcinoids less than 1 cm in diameter. METHODS: Twenty-one patients pathologically diagnosed with rectal carcinoids following colonoscopy in our hospital from January 2007 to November 2012 were included in this study. The patients consisted of 14 men and 7 women, with a mean age of 52.3 ± 12.2 years (range: 36-72 years). The patients with submucosal tumors less than 1 cm in diameter arising from the rectal and muscularis mucosa detected by micro-probe ultrasound were treated with EMR and followed up with conventional endoscopy and micro-probe ultrasound. RESULTS: All of the 21 tumors were confirmed by micro-probe ultrasound as uniform hypoechoic masses originating from the rectal and muscularis mucosa, without invasion of muscularis propria and vessels, and less than 1 cm in diameter. EMR was successfully completed without bleeding, perforation or other complications. The resected specimens were immunohistochemically confirmed to be carcinoids. Patients were followed up for one to two years, and no tumor recurrence was reported. CONCLUSION: EMR is a safe and effective treatment for rectal carcinoids less than 1 cm in diameter.     

Resection of multiple rectal carcinoids with transanal endoscopic microsurgery:Case report

Multiple rectal carcinoids are rare.Due to the unreliability of endoscopic polypectomy in treating these submucosal lesions,a laparotomy is usually performed.We present a case report on multiple rectal carcinoids with three carcinoid foci<10 mm in diameter located in the midrectum.Preoperative examination showed the lesions to be confined to the submucosal layer with no perirectal nodal involvement.A transanal endoscopic microsurgerywas successfully performed to remove the three lesions with accurate full-thickness resection followed by secured suture closure.The postoperative pathology revealed neuroendocrine tumors G1(carcinoids)located within the submucosal layer without lymphatic or vessel infiltration.Both the deep and lateral surgical margins were completely free of tumor cells.The patient recovered quickly and uneventfully.No tumor recurrence was observed at the six-month follow-up.For the multiple small rectal carcinoids without muscularis propria or lymphatic invasion,transanal endoscopic microsurgery offers a reliable and efficient alternative approach to traditional laparotomy for select patients,with the added advantages of minimally invasive surgery.     

胃异位胰腺的内镜诊治

目的探讨胃异位胰腺胃镜和超声内镜的表现及内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)对胃异位胰腺的疗效与安全性。方法经胃镜及超声内镜诊断为胃异位胰腺患者17例,总结其临床症状、胃镜和超声内镜下表现,将有临床症状的16例患者行ESD治疗,另1例患者随访观察。结果胃镜下多表现为隆起性病变,顶部可见导管开口呈脐样凹陷;14例患者行超声内镜检查,病灶以累及黏膜下层为主,可累及固有肌层,多数为低回声、等回声或混合回声改变;16例患者接受ESD治疗,术中发现2例患者累及固有肌层,术中、术后无出血、穿孔等并发症。术后病检提示累及固有肌层3例,随访发现1例患者病灶存在,1例未行手术患者病灶无明显变化。结论胃镜及超声内镜检查是诊断胃异位胰腺及指导治疗的重要手段。ESD可安全、有效地应用于胃异位胰腺的治疗,并发症发生率低,无症状患者可随访观察。     

Efficacy of endoscopic submucosal resection with a ligation device for removing small rectal carcinoid tumor compared with endoscopic mucosal resection: analysis of 100 cases

Aim Conventional endoscopic mucosal resection (EMR) of carcinoid tumors is often associated with involvement of the resection margin, which necessitates further intervention. Endoscopic submucosal resection with a ligation device (ESMR‐L) is a novel technique for the removal of carcinoid tumors. The aim of the present study was to compare the clinical usefulness of endoscopic submucosal resection with a ligation device with that of EMR for the complete resection of rectal carcinoid tumors. Methods Between January 2001 and October 2010, a total of 100 patients with 100 rectal carcinoid tumors that were estimated to be 10 mm or less in diameter and that were resected either using ESMR‐L or EMR were recruited for this study. The complete resection rate and complications associated with these two procedures were analyzed. Results Forty‐five out of 100 lesions were resected using ESMR‐L, and 55 lesions were resected using EMR. Histopathologically, all tumors were free from lymphovascular and perineural invasion. The overall ESMR‐L complete resection rate was higher than that of EMR (93.3% vs 65.5%, respectively, P = 0.001). Furthermore, the location of the tumors had no influence on the complete resection rate when ESMR‐L was carried out, in contrast to the results of EMR. The procedure‐related variables of procedure time and complication rate were not significantly different between the two groups. Conclusion ESMR‐L is a significantly superior modality to EMR for the complete removal of small rectal carcinoid tumors that are 10 mm or less in diameter.     

Indications of Endoscopic Polypectomy for Rectal Carcinoid Tumors and Clinical Usefulness of Endoscopic Ultrasonography

PURPOSE This study was designed to define the indications of endoscopic polypectomy for rectal carcinoid tumors and evaluate the diagnostic value of endoscopic ultrasonography.METHODS A total of 66 rectal carcinoid tumors treated at our hospital were analyzed histopathologically to clarify risk factors for metastasis. The depth of invasion was determined for 52 lesions examined by endoscopic ultrasonography, and the value of endoscopic ultrasonography for deciding whether a lesion is indicated for endoscopic polypectomy was assessed.RESULTS None of the 57 lesions measuring 10 mm in diameter invaded the muscularis propria or had metastasis. Of nine lesions with a diameter of 11 mm, five invaded the muscularis propria and four had metastasis. A central depression was found in three of the lesions with metastasis. The depth of invasion of 49 lesions examined by endoscopic ultrasonography was limited to the submucosa; 3 lesions invaded the muscularis propria. The depth of invasion of all lesions was correctly diagnosed by endoscopic ultrasonography. Ninety-six percent of the lesions that had submucosal invasion with narrowing of the upper two-thirds of the third layer (submucosa) as evaluated by endoscopic ultrasonography could be completely resected by endoscopic polypectomy.CONCLUSIONS Rectal carcinoid tumors that satisfy the following three conditions are indicated for local resection, including endoscopic polypectomy: a maximum diameter of 10 mm, no invasion of the muscularis propria, and no depression or ulceration in the lesion. Endoscopic ultrasonography also is useful for estimating the depth of invasion of rectal carcinoid tumors and for determining whether endoscopic polypectomy is indicated.Published online: 28 January 2005.Reprints are not available.     

The use of endoscopic ultrasonography and other imaging modalities in the preoperative staging of rectal villous tumours: A case of overstaging by magnetic resonance imaging

A case of a 60-year-old man with recurrent rectal villous adenoma is described. Preoperative staging with endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI) revealed very discordant results. EUS showed a tumour present in the mucosa with no submucosal invasion, while MRI revealed invasion of the muscularis propria consistent with an invasive stage T2 carcinoma. Based on the MRI findings, the patient underwent a low anterior resection of the tumour. The surgical pathology specimen revealed a villous adenoma with low-grade dysplasia but no carcinoma and no extension into the muscularis propria. The present case highlights the uncertainty that currently exists as to which imaging modality provides the greatest accuracy in the staging of rectal cancer and in guiding the type of surgical procedure performed. Two recent meta-analyses and a systematic review of the literature point to EUS as the imaging modality of choice for determining muscularis propria and perirectal tissue invasion, as well as nodal involvement.     

Endoscopic submucosal resection with a ligation device is an effective and safe treatment for carcinoid tumors in the lower rectum

Background and Aims: Various methods for complete endoscopic resection of rectal carcinoid tumors have been reported; however, the number of cases investigated in each study has been limited. The aim of the present study was to clarify the clinical usefulness of a novel technique named endoscopic submucosal resection with a ligation device (ESMR‐L) in a large number of rectal carcinoid tumors. Patients and methods: Between January 1999 and March 2005, a total of 61 patients with 63 rectal carcinoid tumors estimated at 10 mm or less in diameter, without atypical features and resected by ESMR‐L were recruited for this analysis. The complete resection rate, complications associated with the procedure, local recurrence, and distant metastases were evaluated. Results: Sixty‐one patients were 36 males and 25 females with a mean age of 59 ± 11 years (24–76 years). Tumor size ranged from 2 to 12 mm in diameter, with an average size of 6.4 ± 2.4 mm. Fifty‐nine lesions (93.6%) were located in the lower rectum (Rb), three in the upper rectum (Ra) and one in the recto‐sigmoid colon (Rs). In total, 60 out of 63 lesions (95.2%) were histologically determined to be completely resected. The complete resection rate for lesions located in the Rb was 98.3%, which was significantly higher than that for lesions in Ra and Rs (50%). Minor bleeding associated with the procedure occurred in five lesions (7.9%), but all cases were successfully managed with hemoclips. Histopathologically, all tumors were located in the submucosal layer, and all were classified as classical‐type carcinoids without lymphovascular invasion. Neither local recurrence nor distant metastasis was detected during a median follow‐up period of 24 months. Conclusion: In a large number of cases, ESMR‐L proved to be a useful and safe procedure to resect rectal carcinoid tumors 10 mm or less in diameter, especially for those located in the Rb.