Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
Clin Res Hepatol Gastroenterol. 2013 Jun;37(3):275-82. doi: 10.1016/j.clinre.2012.07.007. Epub 2012 Sep 5.
Despite a growing understanding of the clinical effectiveness of endoscopic treatment for small rectal carcinoid tumors, there is still controversy concerning the best endoscopic treatment for resecting rectal carcinoid tumors easily and effectively.
The objective of the present study was to compare the therapeutic efficacy and safety of endoscopic submucosal resection with a ligation device (ESMR-L) with endoscopic submucosal dissection (ESD) for rectal carcinoid tumors. In addition, a conventional snare-based endoscopic mucosal resection (EMR) was included in the study and compared with both ESMR-L and ESD.
A retrospective analysis was performed in 115 patients who underwent endoscopic resection of a rectal carcinoid tumor between January 2005 and June 2011. These patients were classified into three groups according to the type of endoscopic procedure: EMR group (n=33), ESMR-L group (n=40) and ESD group (n=44).
The complete resection rate of the EMR group was significantly lower than those of the ESMR-L and ESD groups (77.4 vs. 100 and 97.7%, P=0.002 and P=0.007). Tumor-free vertical margins were significantly greater in the ESMR-L and ESD groups than in the EMR group (ESMR-L and ESD vs. EMR group, P=0.013 and P=0.041). The curative resection rate of rectal carcinoid tumors in the EMR group was 77.4%, which was significantly lower than that of the ESMR-L (95%, 38/40) and EDS groups (97.7%, 43/44) (77.4% vs. 95%, P=0.036 and 77.4% vs. 97.7%, P=0.007).
Our results show that ESMR-L and ESD might be superior to conventional EMR for the treatment of small rectal carcinoid tumors.
尽管人们对内镜治疗小直肠类癌的临床疗效有了更多的了解，但对于如何有效地切除直肠类癌，哪种内镜治疗方法最佳仍存在争议。
本研究旨在比较内镜黏膜下剥离术（ESD）联合结扎装置（ESMR-L）与 ESD 治疗直肠类癌的疗效和安全性，并与传统的圈套内镜黏膜切除术（EMR）进行比较。
回顾性分析 2005 年 1 月至 2011 年 6 月间 115 例行内镜下直肠类癌切除术患者的临床资料，根据内镜手术方式分为 EMR 组（n=33）、ESMR-L 组（n=40）和 ESD 组（n=44）。
EMR 组的完全切除率明显低于 ESMR-L 组和 ESD 组（77.4%比 100%和 97.7%，P=0.002 和 P=0.007）。ESMR-L 组和 ESD 组的肿瘤无垂直切缘均明显大于 EMR 组（ESMR-L 组和 ESD 组比 EMR 组，P=0.013 和 P=0.041）。EMR 组直肠类癌的根治性切除率为 77.4%，明显低于 ESMR-L 组（95%，38/40）和 ESD 组（97.7%，43/44）（77.4%比 95%，P=0.036；77.4%比 97.7%，P=0.007）。
我们的结果表明，ESMR-L 和 ESD 可能优于传统的 EMR 治疗小直肠类癌。
