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中华胃肠内镜电子杂志 ›› 2023, Vol. 10 ›› Issue (03) : 173 -179. doi: 10.3877/cma.j.issn.2095-7157.2023.03.006

论著

内镜下不同术式治疗直肠神经内分泌肿瘤临床研究
倪修凡, 陈磊, 印健, 张利, 高苏俊, 朱振()   
  1. 225001 扬州,扬州大学附属苏北人民医院消化内科
  • 收稿日期:2023-01-04 出版日期:2023-08-15
  • 通信作者: 朱振
  • 基金资助:
    江苏省苏北人民医院科研基金项目(SBKY21035)

Clinical study of different endoscopic resection methods in the treatment of rectal neuroendocrine tumors

Xiufan Ni, Lei Chen, Jian Yin, Li Zhang, Sujun Gao, Zhen Zhu()   

  1. Department of Gastroenterology, Clinical Medical College, Yangzhou University/Northern Jiangsu People′s Hospital Affiliated to Yangzhou University, Yangzhou 225001, China
  • Received:2023-01-04 Published:2023-08-15
  • Corresponding author: Zhen Zhu
引用本文:

倪修凡, 陈磊, 印健, 张利, 高苏俊, 朱振. 内镜下不同术式治疗直肠神经内分泌肿瘤临床研究[J/OL]. 中华胃肠内镜电子杂志, 2023, 10(03): 173-179.

Xiufan Ni, Lei Chen, Jian Yin, Li Zhang, Sujun Gao, Zhen Zhu. Clinical study of different endoscopic resection methods in the treatment of rectal neuroendocrine tumors[J/OL]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2023, 10(03): 173-179.

目的

回顾性分析内镜下黏膜切除术(c-EMR)、内镜下改良黏膜切除术(m-EMR)以及内镜黏膜下剥离术(ESD)治疗<10 mm以及≥10 mm的直肠神经内分泌肿瘤(R-NEN)的有效性及安全性。

方法

回顾性分析2012年5月至2022年5月江苏省苏北人民医院消化胃肠中心收治的120例R-NEN患者的临床资料及随访情况,比较内镜下不同术式治疗R-NEN的整块切除率、组织学完整切除率、术后并发症、手术时间及随访情况。

结果

共纳入患者120例,24例行c-EMR、30例行m-EMR、66例行ESD。临床疗效对比:肿瘤直径<10 mm患者共79例,行c-EMR 16例、行m-EMR 18例、行ESD45例,三组整块切除率、组织学完整切除率比较均无明显统计学差异(P>0.05)。肿瘤直径≥10 mm患者共41例,行c-EMR8例、行m-EMR12例、行ESD21例,m-EMR及ESD组比c-EMR组组织学完整切除率更高,差异有统计学意义(P<0.05)。c-EMR组及m-EMR组比ESD组手术时间短,有统计学意义(P<0.05)。

结论

对于R-NEN的内镜下治疗,c-EMR、m-EMR及ESD在治疗<10 mm的R-NEN中均具有安全性及有效性,但对于≥10 mm的R-NEN治疗建议选择m-EMR或ESD。无论选用何种术式治疗,术后规律性随访仍然重要。

Objective

To retrospectively analyze the safety and efficacy of conventional-endoscopic mucosal resection(c-EMR), modified-endoscopic mucosal resection (m-EMR) and endoscopic submucosal dissection (ESD) in the treatment of <10 mm and ≥10 mm rectal neuroendocrine tumor (R-NEN).

Methods

The total of 120 patients with R-NEN confirmed by postoperative pathological results who receive treatment in the Gastrointestinal Center of Northern Jiangsu People′s Hospital from May 2012 to May 2022 were selected as the study subjects. We retrospectively analyzed the en bloc resection rate, histological complete resection, operative complication, and time of different endoscopic procedures.

Results

A total of 120 patients were included, of which 24 underwent c-EMR, 30 underwent m-EMR and 66 underwent ESD.There were 79 patients in the diameter<10 mm group, 16 patients underwent c-EMR, 18 patients underwent m-EMR, 45 patients underwent ESD. There were no significant differences in the en bloc resection rate and histological complete resection among the three groups (P>0.05). There were 41 patients in the diameter ≥10 mm group, 8 patients underwent c-EMR, 12 patients underwent m-EMR, 21 patients underwent ESD. The histological resection rate of m-EMR and ESD group was higher than that of c-EMR group, and the difference was statistically significant (P<0.05). The operation time of c-EMR and m-EMR group was shorter than that of ESD group among patients in the diameter <10 mm group and ≥10 mm group.

Conclusion

C-EMR, m-EMR and ESD can effectively and safely resect R-NEN with tumor diameter <10mm, but m-EMR and ESD are recommended for ≥10 mm tumors. Follow-up is still important no matter which endoscopic procedure was chosen.

图1 内镜下传统黏膜切除术治疗直肠神经内分泌肿瘤注:A:术前肿瘤图片;B:术中圈套器电凝电切;C:术后创面
图2 内镜下透明帽辅助下黏膜切除术治疗直肠神经内分泌肿瘤注:A:术前肿瘤图片;B:术中黏膜下注射;C:术后创面情况
图3 内镜下联合套扎装置下黏膜切除术治疗直肠神经内分泌肿瘤注:A:术前肿瘤图片;B:术中套扎肿瘤;C:术后创面情况
图4 内镜下钛夹-圈套器辅助下黏膜切除术治疗直肠神经内分泌肿瘤注:A:术前肿瘤图片;B:术中钛夹提拉圈套器置入;C:术后创面情况
图5 内镜下黏膜下剥离术治疗直肠神经内分泌肿瘤注:A:术前肿瘤标记;B:术中Dual刀黏膜下剥离;C:术后创面情况
表1 STR-NEN患者基线资料分析[例(%)]
表2 内镜下不同术式对于R-NEN的治疗效果比较[n/n(%)]
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