内镜黏膜下剥离术治疗胃肠道神经内分泌肿瘤的临床观察

Endoscopic submucosal dissection in treatment of gastrointestinal neuroendocrine neoplasms

摘要:

目的??探讨内镜黏膜下剥离术（ESD）在胃肠道神经内分泌肿瘤（GI-NENs）治疗中的安全性和有效性。方法?回顾性分析该院2011年1月-2015年12月52例经ESD治疗的GI-NENs患者临床资料，总结其内镜下形态，记录完整切除率，并发症发生率，病理特征以及随访结果。结果?52例患者中胃16例，结肠9例，直肠27例；大部分病灶为黏膜下隆起，少数为不典型的息肉样改变；所有病灶均一次性整块切除病变，其中G1 44例，G2 8例；完整切除率94.23%（49/52）；2例直肠病灶侵犯固有肌层，追加外科手术；1例直肠穿孔，内镜下处理及保守治疗好转。全组病例未出现大出血，术后平均随访22.6个月，1例胃病灶发生局部复发，行第二次ESD治疗，未发现淋巴结和远处转移病例。结论?严格把握内镜治疗适应证，ESD治疗GI-NENs是可行、安全、有效的。

Abstract:

Objective?To investigate the feasibility and efficacy of endoscopic submucosal dissection (ESD) for gastrointestinal neuroendocrine neoplasms (GI-NENs).?Methods?52 patients with confirmed histological diagnosis of GI-NENs performed ESD from January 2011 to December 2015 were included. The endoscopic morphology of tumor was summarized. Complete resection rate, complications, clinicopathological characteristics, and follow-up results were evaluated.?Results?There were 16 cases of stomach, 9 cases of colon and rectum 27 cases. Most of the lesions were submucosal uplift. A few of lesions looked like polyps. All the lesions were one-time whole diseased. 44 lesions were NET-G1, 8 lesions were NET-G2. Complete resection rate was 94.23%. 2 cases of rectal lesions infringemented intrinsic muscle layer, and got additional surgery. 1 case of rectal perforation, which was managed by endoscopic treatment and conservative treatment. All cases did not appear haemorrhage. During a mean follow-up period of 22.6 months, local recurrences occurred in 1 case of stomach, and treated with second line ESD. No cases lymph node and distant metastasis were found.?Conclusion?ESD appears to be a feasible, safe and effective treatment for GI-NENs with strict endoscopic treatment indications.