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。

Endoscopic ultrasonography and endoscopic submucosal resection in the diagnosis and treatment of rectal carcinoid tumors

Objective To evaluate the clinical value of endoscopic ultrasonography(EUS)and endo- scopic submucosal resection(ESMR)in the diagnosis and treatment of rectal carcinoid tumors.Methods EUS was performed in 126 patients with elevated lesions that had normal mucosal appearence under colonos- copy.Lesions diagnosed as rectal carcinoids were resected by using ligator-assisted with snare resection tech- niques.The diagnostic results of EUS were compared with pathological findings of specimens by ESMR.Re- sults Twenty-five cases with rectal carcinoids were diagnosed by EUS under colonoscopy and all cases were verified by pathological examination.Rectal carcinoids were presented as submucosal hypoechoic masses with homogenous echo and distinct border.All cases had no infiltration to muscularis propria and vessel.Com- plete resection was achieved in all cases with no bleeding and perforation.No tumor residues at the border or base of the resected specimens.Conclusion EUS can provide precise information of rectal carcinoid about its size,depth,border,muscularis propria and vessel infiltration,and therapeutic result of ESMR for rectal carcinoid is definite.