Kudo Shin-ei, Fumio Ishida, Shungo Endo, Nobunao Ikehara, Hideyuki Miyachi
Digestive Disease Center, Northern Yokohama Hospital, Showa University School of Medicine, Yokohama, Japan.
Nihon Geka Gakkai Zasshi. 2011 Sep;112(5):304-8.
Endoscopic treatment for early rectal cancer was investigated. The characteristics of early rectal cancer were compared with those of early colon cancer, and the advantages of endoscopic treatment were evaluated. The indications for endoscopic resection are mucosal cancer, slight submucosal invasion without vessel or lymphatic involvement, poorly differentiated adenocarcinoma, and sprouting. The presence of other characteristics indicates the need for surgical resection. Early rectal cancers in the form of laterally spreading tumors of the non-granular, pseudodepressed type should be treated with endoscopic submucosal dissection due to the high incidence of submucosal invasion. The decision on the procedure for the treatment of early rectal cancer may be complicated because of the anatomic character and function of the ano-rectal area, complications of anal dysfunction, and incidence of leakage from the anastomosis after surgery. A precise diagnosis after endoscopic examination based on the pit pattern with magnifying endoscopy may be an effective aid in selecting the most appropriate endoscopic treatment for early rectal cancer.
对早期直肠癌的内镜治疗进行了研究。将早期直肠癌的特征与早期结肠癌的特征进行了比较，并评估了内镜治疗的优势。内镜切除的适应证为黏膜癌、无血管或淋巴管受累的轻度黏膜下浸润、低分化腺癌和萌芽。存在其他特征则表明需要进行手术切除。非颗粒状、假凹陷型侧向扩散肿瘤形式的早期直肠癌，由于黏膜下浸润发生率高，应采用内镜黏膜下剥离术治疗。由于肛管直肠区域的解剖特点和功能、肛门功能障碍的并发症以及术后吻合口漏的发生率，早期直肠癌治疗方法的决策可能会很复杂。基于放大内镜下的凹坑形态在内镜检查后进行精确诊断，可能有助于为早期直肠癌选择最合适的内镜治疗方法。
