目的： 比较无黏膜下注射的结扎装置辅助黏膜下组织切除术（endoscopic submucosal resection with ligation, ESMR-L）和内镜黏膜下剥离术 （endoscopic submucosal dissection, ESD）治疗直径≤1 cm的直肠神经内分泌肿瘤（neuroendocrine tumor, NET）的有效性及安全性。方法： 前瞻性研究2020年10月至2021年10月期间在上海交通大学医学院附属瑞金医院接受内镜治疗的42例直径≤1 cm直肠NET患者,随机化入无黏膜下注射的ESMR-L组和ESD组,分别治疗21个病灶,比较2种内镜治疗方法的平均手术时间、病灶切缘、组织学完整切除率以及肿瘤下缘与垂直切缘距离等临床病理学特点。结果： 无黏膜下注射ESMR-L组的手术时间明显短于ESD组[（10.10±1.37） min比（29.90±3.81） min,P<0.001];2组侧切缘及垂直切缘均为阴性,组织学完整切除率均为100%,差异无统计学意义（P>0.05）;无黏膜下注射ESMR-L组的肿瘤下缘到垂直切缘的距离明显长于ESD组[（1 051.5±561.4） μm比（612.6±305.4） μm,P=0.038]。结论： 与ESD相比,无黏膜下注射ESMR-L能有效缩短手术时间,且具有同样的病变完整切除率,是直径≤1 cm的直肠 NET简单、安全且有效的治疗方法。

Objective To compare the efficacy and safety of endoscopic submucosal resection with ligation (ESMR-L) with non-submucosal injection and endoscopic submucosal dissection (ESD) on management of rectal neuroendocrine tumor (NET). Methods The prospective study included 42 patients who had rectal NET with a diameter ≤1 cm and received endoscopic treatment in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from October 2020 through October 2021. Twenty-one patients were treated with ESD and 21 patients were treated with non-submucosal injection ESMR-L. The average operation time and histopathological characteristics, such as complete resection rate and the distance between the lower edge of the tumor and the vertical cutting edge, were compared between the two groups. Results The operation time in non-submucosal injection ESMR-L group was significantly shorter than that in ESD group[(10.10±1.37) min vs (29.90±3.81) min, P<0.001]; The lateral and vertical margins of the two groups were both negative, and patients of both group all had the lesions complete resected (P>0.05); The distance from the lower edge of tumor to the vertical cutting edge in non-submucosal injection ESMR-L group was significantly longer than that in ESD group [(1 051.5±561.4) μm vs(612.6±305.4) μm, P=0.038]. Conclusions Compared with the ESD method, non-submucosal ESMR-L method needs shorter operation time while achieving similar rate of complete lesion resection. ESMR-L is therefore a simple, safe and effective treatment for rectal NET with diameter ≤1 cm.