内镜黏膜下剥离术治疗直肠类癌的临床价值

目的探讨内镜下对直肠类癌的诊断与治疗的临床价值。方法肠镜发现直肠黏膜下肿块后进行微探头超声检查，对诊断为类癌的患者应用头端弯曲的针形切开刀进行内镜黏膜下剥离术（ESD）治疗：黏膜下注射生理盐水抬高病灶，使病灶与肌层分离；预切开病灶周围黏膜；剥离病变下方黏膜下层结缔组织，完整切除病灶。结果ESD手术时间（自黏膜下注射至完整剥离病变）25～55min；术中创面出现少量出血，均经电凝、氩离子血浆凝固和止血夹成功止血，不需再次肠镜下止血。术后全部经病理确诊，基底和切缘未见病变累及。1个月后肠镜复查，创面基本愈合。结论ESD是治疗直肠类癌的一种新方法，以往需要外科手术切除的肿瘤通过ESD可以达到同样的治疗效果。

Clinical value of endoscopic submucosal dissection for rectal carcinoid tumor

Objective To assess the clinical value of endoscopic submucosal dissection （ESD） for rectal carcinoid tumors. Methods Endoscopic miniprobe uhrasonography was performed in patients with rectal submucosal tumors under colonoscope. ESI） was carried out with the needle knife for lesions diagnosed as rectal carcinoid as follows： Physiologic saline was injected into the sub- mucosal layer in the rectum to elevate the lesion from the muscle layer. The surrounding mucosa o5 the lesion was precut. The connective tissue of the submucosa beneath the lesion was dissected. Re- suits The mean ESD procedure time （from fluid injection to complete dissection） was 40 min （ranging from 25 to 55 min）. Minor bleeding occurred in all of the tumors and was stanched by electrohemostasis, argon plasma coagulation and hemostatic clip, and none bleeding required hemostasis under colonoscopy once again. All excisional tissues were examined by pathological diag- nosis, basal and incisal margin were not involved by tumor. All patients were followed up with colonoscopy 1 month after ESD, which confirmed the healing of artificial ulcers. Conclusion ESD is a novel endoscopic treatment that makes it possible to resect the whole rectal carcinoids. Rectal carcinoid tumors can now be treated by ESD to achieve the same therapeutic effect as operation.