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  

A control study of endoscopic mucosal resection and endoscopic submucosal dissection in treating rectal carcinoid tumors

作　　者：窦利州[1] 张月明[1] 贺舜[1] 邹霜梅[2] 吕宁[2] 赵东兵[3] 秦秀敏[1] 刘勇[1] 赖少清[1] 倪晓光[1] 张蕾[1] 于桂香[1] 鞠凤环[1] 荀华英[1] 朱娜[1] 王贵齐[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院肿瘤研究所内镜科,北京100021 [2]北京协和医学院中国医学科学院肿瘤医院肿瘤研究所病理科,北京100021 [3]北京协和医学院中国医学科学院肿瘤医院肿瘤研究所腹部外科,北京100021

出　　处：《中华消化内镜杂志》2013年第4期209-213,共5页Chinese Journal of Digestive Endoscopy

摘　　要：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7mm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7mm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。Objective To evaluate the efficacy and safety of endoscopic submucosal dissection （ESD） for rectal carcinoid tumors by comparing with endoscopic mucosal resection （EMR）. Methods Da ta of patients with rectal eareinoid tumors between May 2010 to May 2012, who received EMR （n = 24） or ESD （n = 19 ） were reviewed to compare the diameter measured by EUS, operation time, en bloc resection rate, complication, R0 resection rate, and recurrence rate between two methods. Results Diameter measured by EUS in ESD group （ 7.4 ± 5.3 mm ） was significantly higher than that in EMR group （ 5.6 ± 2. lmm, P 〈0. 05）. Mean operation time of ESD group （32. 6 ± 10. 5 min） was significantly longer than that of EMR group （8. 9 ±6. 3 min, P 〈0.05）. En bloc resection and R0 resection rates were similar between EMR （ 100. 0%, 100.0% , respectively） and ESD group （ 100. 0% , 95.0% , respectively）. Complications including perforation and delayed bleeding in EMR group （ 15. 3% ） was significantly higher than those in ESD groups （ 5.0% , P 〈 0. 05 ）. No local recurrence had been detected in either the EMR or ESD group. Conclusion For rectal earcinoid tumor with diameter less than 7mm, EMR can effectively achieve complete resection of the lesions and shorten the operation time. For lesions with diameter greater than 7mm, after muhiple biopsies or partial resection, which results in endoscopic injection flattering intrinsic-negativesigns, ESD might be a better choice.

关 键 词：直肠 类癌 内镜下黏膜切除术 内镜黏膜下剥离术 

分 类 号：R735[医药卫生—肿瘤]