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中华胃肠内镜电子杂志 ›› 2023, Vol. 10 ›› Issue (01) : 41 -45. doi: 10.3877/cma.j.issn.2095-7157.2023.01.012

论著

内镜下新型金属夹联合圈套器辅助内镜下黏膜切除术治疗直肠神经内分泌瘤疗效及安全性分析
曹友红, 马亦旻, 张康伟, 孔令超, 徐甜, 邢一鸣, 吕奇珠, 姜云方, 徐桂芳()   
  1. 211300 江苏高淳,南京市高淳人民医院消化科
    211300 江苏高淳,南京市高淳淳溪医院
    210008 南京,南京大学附属鼓楼医院消化科
  • 收稿日期:2023-01-03 出版日期:2023-02-15
  • 通信作者: 徐桂芳
  • 基金资助:
    江苏卫生健康职业学院校级科研项目(JKC202007)

Efficacy and safety analysis of CS-EMR in the treatment of rectal neuroendocrine tumors

Youhong Cao, Yimin Ma, Kangwei Zhang, Lingchao Kong, Tian Xu, Yiming Xing, Qizhu Lü, Yunfang Jiang, Guifang Xu()   

  1. Department of Gastroenterology, NanJing Gaochun People′s Hospital, Nanjing 211300, China
    Department of Gastroenterology, NanJing Gaochun Chunxi Hospital, Nanjing 211300, China
    Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
  • Received:2023-01-03 Published:2023-02-15
  • Corresponding author: Guifang Xu
引用本文:

曹友红, 马亦旻, 张康伟, 孔令超, 徐甜, 邢一鸣, 吕奇珠, 姜云方, 徐桂芳. 内镜下新型金属夹联合圈套器辅助内镜下黏膜切除术治疗直肠神经内分泌瘤疗效及安全性分析[J/OL]. 中华胃肠内镜电子杂志, 2023, 10(01): 41-45.

Youhong Cao, Yimin Ma, Kangwei Zhang, Lingchao Kong, Tian Xu, Yiming Xing, Qizhu Lü, Yunfang Jiang, Guifang Xu. Efficacy and safety analysis of CS-EMR in the treatment of rectal neuroendocrine tumors[J/OL]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2023, 10(01): 41-45.

目的

对比内镜下新型金属夹联合圈套器辅助内镜下黏膜切除术(CS-EMR)与内镜黏膜下剥离术(ESD)切除方法治疗直径约10 mm以下直肠神经内分泌瘤(NET)的疗效分析。

方法

回顾性分析2019年9月至2022年9月南京市高淳人民医院消化科收治的43例直肠神经内分泌瘤患者,其中,男23例、女20例,平均年龄(54.27±11.48)岁。按手术方式分为两组:ESD组27例、CS-EMR组16例;行相关检查治疗后,术后病理证实NET。其中,27例采用ESD术切除、16例采取CS-EMR术切除;对比两组患者病灶大小、切除面积大小、切除时间、术后病理评估等情况。

结果

CS-EMR组与ESD组两组比较,手术切除面积分别为(46.75±14.65)mm2及(185.96±117.33)mm2P<0.05、手术操作时间为(13.69±3.95)min及(40.26±8.93)min,P<0.05具有显著差异。R0切除,垂直切缘、垂直切缘、血管、淋巴管、神经侵犯、术后并发症发生率、术后追加手术均无明显差异(P>0.05)。

结论

对于位于直肠的无淋巴结转移的直径<1 cm的类癌,CS-EMR、ESD法均为安全有效方法。新型CS-EMR法操作相对简单,手术操作时间和术后住院时间短优势;相比ESD方法并未增加术后切缘阳性及术后追加手术比率。

Objective

To compare the efficacy of two different endoscopic resection methods in the treatment of rectal neuroendocrine tumors (NET) less than 10mm in diameter.

Methods

A total of 43 cases of rectal submucosal tumors from September 2019 to September 2022 were retrospectively collected. After relevant examination and treatment in our hospital, postoperative pathological findings of rectal neuroendocrine tumors were confirmed.27 cases were resected by ESD and 16 cases by CS-EMR. The size of lesion, resection area, resection time and postoperative pathological evaluation were compared between the two groups.

Results

The surgical resection area of CS-EMR group and ESD group was (46.75±14.65) mm2 and (185.96±117.33)mm2, respectively P<0.05, operation time (13.69±3.95)min compared with (40.26±8.93) min, P<0.05, there were significant differences.There were no significant differences in R0 resection, vertical resection margin, vascular, lymphatic, nerve invasion, incidence of postoperative complications, and postoperative additional operation (P>0.05).

Conclusion

Both CS-EMR and ESD methods are safe and effective for carcinoids with a diameter of less than 1 cm located in the rectum without lymph node metastasis. New-style(CS-EMR) method is relatively simple to operate, and has advantages of short operation time and postoperative hospital stay. Compared with ESD method, there was no increase in the rate of positive postoperative margin and postoperative additional surgery.

表1 神经内分泌瘤患者一般资料及病灶手术及后续情况[例(%)]
图1 内镜下金属夹联合圈套器辅助内镜下黏膜切除术CS-EMR操作过程 注:A:体外将单股圈套器套于透明帽上,随内镜一起进入直肠腔内,寻找病变位置;B:通过内镜活检孔道置入和谐夹,夹脚张开;C:在直肠NET病变根部和谐夹脚深压后进行病变的提拉;D:圈套器释放调整抵压至到达直肠类癌病变根部;E:通过电刀进行电切电凝,使病变完成切除
图2 内镜下黏膜剥离术(ESD)操作过程 注:A:常规治疗镜带透明帽寻找至病变;B:在病变周边处进行黏膜下注射,同时切开病变边缘;C:在黏膜下层逐渐剥离病变至病变完整切除;D:切除的ESD离体标本予以"昆虫针"反面平铺固定于泡沫面板上
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