内镜黏膜下剥离术治疗直肠类癌

目的探讨内镜黏膜下剥离术（ESD）治疗直肠类癌的应用价值。方法肠镜发现直肠黏膜下肿块后进行微探头超声检查，对诊断为类癌者应用头端弯曲的针形切开刀进行内镜黏膜下剥离术治疗：（1）黏膜下注射生理盐水抬高病灶，使病灶与肌层分离；（2）预切开病灶周围黏膜；（3）剥离病变下方黏膜下层结缔组织，完整切除病灶。结果5例直肠类癌患者，肿瘤直径0.4～1.2（平均1．1）cm，均成功完成ESD治疗。ESD手术时间（自黏膜下注射至完整剥离病变）20-45（平均35）min；术中创面少量出血，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。1例剥离深至肌层，出现皮下气肿，保守治疗好转。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。

Endoscopic submucosal dissection for rectal carcinoid tumors

OBJECTIVE: To assess the clinical value of endoscopic submucosal dissection(ESD)for rectal carcinoid tumors. METHODS: Endoscopic miniprobe ultrasonography was performed in patients with rectal submucosal tumors under colonoscope. ESD was carried out with the needle knife for lesions diagnosed as rectal carcinoid as following: (1)Fluid was injected into the submucosal layer in the rectum to elevate the lesion from the muscle layer. (2)The surrounding mucosa of the lesion was pre-cut. (3)The connective tissue of the submucosa beneath the lesion was dissected. RESULTS: Five rectal carcinoids ranged from 0.4 to 1.2 cm and the mean resected size was 1.1 cm. All rectal carcinoid tumors were verified by pathological examination with lateral and basal resection margins free of tumor. The mean ESD procedure time (from fluid injection to complete dissection) was 35 min (ranged from 20 to 45 min). Minor bleeding occurred in all of the tumors, and none of patients had massive hemorrhage requiring blood transfusion or emergency colonoscopy due to hematochezia after ESD. One patient had subserosal emphysema due to deep tearing of the muscle layer, and recovered after several days' conservative treatment. All patients were followed up with colonoscopy 1 month after ESD,which confirmed the healing of artificial ulcers. CONCLUSIONS: 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.