Moon J H, Kim J H, Park C H, Jung J O, Shin W G, Kim J P, Kim K O, Hahn T, Yoo K-S, Park S H, Park C K
Department of Internal Medicine, Hallym University, College of Medicine, Anyang, Republic of Korea.
Endoscopy. 2006 May;38(5):511-4. doi: 10.1055/s-2006-925074.
It is difficult to achieve complete endoscopic resection of rectal carcinoid tumors without any procedure-related complications. In this study, we evaluated the efficacy and safety of endoscopic submucosal resection with double ligation (ESMR-DL) for the treatment of small rectal carcinoid tumors.
Eleven rectal carcinoid tumors (in 11 patients) were resected by ESMR-DL between November 2001 and April 2004, using a conventional single-channel endoscope with an attached band-ligator device. The lesion was aspirated into the ligator device and an elastic band was placed around the base; a detachable snare was then used to ligate the stalk below the elastic band; and snare resection was performed above the elastic band. The resected specimens were examined with respect to size, histological atypia, depth of invasion, and the histological appearance of the resection margins.
All the lesions were excised completely without any complications. There was no tumor invasion beyond the submucosal layer and there was no evidence of atypia in any of the specimens. Tumor diameter varied from 2.0 mm to 10.0 mm (average 6.2 mm). None of the 11 specimens showed histopathological evidence of tumor involvement at the resection margins. There were no immediate or late complications (bleeding or perforation) after ESMR-DL. There was no local recurrence and there were no distant metastases in any patients during the mean follow-up period of 18 months.
Endoscopic submucosal resection with double ligation is a useful and safe method for the treatment of small rectal carcinoid tumors.
直肠类癌瘤的内镜下完整切除且无任何手术相关并发症很难实现。在本研究中，我们评估了双结扎内镜黏膜下切除术（ESMR-DL）治疗直肠小类癌瘤的疗效与安全性。
2001年11月至2004年4月期间，使用带有套扎装置的传统单通道内镜，通过ESMR-DL对11例患者的11个直肠类癌瘤进行了切除。将病变吸入套扎装置，在其基部放置一个弹性圈套；然后使用可分离圈套器在弹性圈套下方结扎蒂部；并在弹性圈套上方进行圈套切除。对切除标本进行大小、组织学异型性、浸润深度及切除边缘组织学表现方面的检查。
所有病变均完整切除，无任何并发症。无一例肿瘤浸润超过黏膜下层，所有标本均无异型性证据。肿瘤直径为2.0毫米至10.0毫米（平均6.2毫米）。11个标本中无一例在切除边缘有肿瘤累及的组织病理学证据。ESMR-DL术后无即刻或延迟并发症（出血或穿孔）。在平均18个月的随访期内，所有患者均无局部复发及远处转移。
双结扎内镜黏膜下切除术是治疗直肠小类癌瘤的一种有效且安全的方法。
