目的 探讨直肠类癌的超声内镜(EUS)诊断与内镜治疗效果.方法 选择2005年6月-2009年12月结肠镜检查发现直肠黏膜隆起件病变,EUS结果高度怀疑直肠类癌且病变<1.0cm的患者进行内镜切除.术后明确病变切除是否完整,切除完整后于病变切除创面边缘取材4～6块同时送检.术后病理评价EUS诊断准确率,分析病变侵袭性状况,以及内镜完整切除率.随访观察每半年1次,复查肠镜及肝脏超声.结果 共纳入直肠黏膜隆起性病变患者27例,均为采用EUS筛查高度怀疑类癌且具有内镜切除指征的患者.内镜切除均取得成功,病理证实类癌符合率92.6%(25/27),1例考虑为间质瘤,1例考虑为颗粒细胞瘤.25例类癌患者随访观察33.7±12.5个月,无复发和转移病例.结论 EUS在直肠黏膜隆起性病变诊断中具有较高准确性,在评价内镜切除指征方面具有不可替代的作用.内镜治疗1.0cm以下直肠类癌安全有效.%Objective To assess the effect of treatment of rectal carcinoid tumors through endoscopy. Methods Endoscopic dissection was performed for patients during Jun. 2005 to Dec. 2009, in whom an elevated lesion in rectal mucosa as seen through colonoscopy, and highly suspected to be rectal carcinoid by endoscopic ultrasound (EUS), with the diameter of the lesion smaller than 1.Ocm, was excised through endoscope. After being proved to be totally excised, endoscopic biopsy was performed at 4 to 6 sites along borderline of the tumor. Accurate rate of EUS was evaluated by postoperative pathology. Invasion and entirety of excised tumor were analyzed by pathological examination. Colonoscopy and liver ultrasound were carried out one time every half a year during the follow-up.Results 27 patients with elevated lesion in rectal mucosa were investigated. Rectal carcinoid was highly suspected in these patients and met the indication for endoscopic excision. The elevated lesion in rectal mucosa was excised successfully by endoscopy in all cases. Postoperative pathology confirmed that corvect diagnosis of rectal carcinoid was 92.6％ (25/27). Interstitialoma was found in 1 patient, and granular cell tumor in another patient. All the 25 patients with rectal carcinoid were followed up with an average follow-up time of 33.7±12.5 months.Metastases and recurrence had not been found. Conclusions EUS has a good diagnostic specificity in the elevated lesion of rectal mucosa,and can accurately assess the indication of endoscopic excision. Endoscopic excision is a safe and effective method for rectal carcinoid which is smaller than 1.0 cm.
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