Higaki S, Nishiaki M, Mitani N, Yanai H, Tada M, Okita K
First Department of Internal Medicine, Yamaguchi University School of Medicine, Japan.
Endoscopy. 1997 Mar;29(3):171-5. doi: 10.1055/s-2007-1004158.
In the treatment of rectal carcinoid tumors, confusion arises in the choice between radical surgery and local endoscopic resection, since the malignancy of individual tumors differs widely. We investigated the appropriateness of using endoscopic therapy for this disease.
Twenty-two patients were diagnosed with rectal carcinoid tumors at the First Department of Internal Medicine, Yamaguchi University School of Medicine and its affiliated hospitals, from 1977 to 1994. The tumors were resected and examined regarding their size, depth of invasion, and histological atypia. The post-treatment course in patients whose tumors were completely resected without atypia was observed by colonoscopy and ultrasonography at yearly intervals.
In 21 patients, tumor invasion did not extend beyond the submucosal layer, and there were no signs of atypia. The size of the tumor varied from 2.2 mm to 10.0 mm in diameter, with an average of 5.4 mm. After endoscopic resection of the tumors in 18 patients and surgical local resection in three patients, no local recurrences or liver metastases were experienced. The patients survived for a minimum of 29 months and a maximum of 237 months; the mean survival period was 72.8 months. In one patient, the tumor showed cellular atypia invading into the tunica muscularis, and measured 25 mm in diameter. The patient underwent surgery, but died ten months later due to liver metastasis.
Endoscopic treatment of rectal carcinoid tumors was found to be appropriate when the tumor measured 10 mm or less in diameter, did not infiltrate beyond the submucosal layer, and had no histological atypia.
在直肠类癌肿瘤的治疗中，由于个体肿瘤的恶性程度差异很大，在根治性手术和局部内镜切除之间的选择上存在困惑。我们研究了对这种疾病使用内镜治疗的适宜性。
1977年至1994年期间，在山口大学医学院第一内科及其附属医院，22例患者被诊断为直肠类癌肿瘤。对肿瘤进行切除，并检查其大小、浸润深度和组织学异型性。对肿瘤完全切除且无异型性的患者，每年通过结肠镜检查和超声检查观察治疗后的病程。
21例患者中，肿瘤浸润未超出黏膜下层，且无异型性迹象。肿瘤直径从2.2毫米至10.0毫米不等，平均为5.4毫米。18例患者经内镜切除肿瘤，3例患者行手术局部切除，术后均未出现局部复发或肝转移。患者存活时间最短为29个月，最长为237个月；平均生存期为72.8个月。1例患者的肿瘤显示细胞异型性，浸润至肌层，直径为25毫米。该患者接受了手术，但10个月后因肝转移死亡。
当直肠类癌肿瘤直径在10毫米或以下、未浸润超出黏膜下层且无组织学异型性时，内镜治疗被认为是合适的。
