内镜下黏膜切除术与内镜黏膜下剥离术治疗消化道神经内分泌肿瘤的对比研究

Comparison of EMR and ESD in treatment of patients with neuroendocrine tumors of digestive tract

摘要:

目的 探讨内镜下黏膜切除术（EMR）和内镜黏膜下剥离术（ESD）对消化道神经内分泌肿瘤 患者围手术期临床指标、完全切除率及并发症的影响。方法 研究对象选取该院2009 年6 月-2016 年6 月 消化道神经内分泌肿瘤患者共40 例，根据手术方案不同分为A 组（20 例）和B 组（20 例），分别采用EMR（A 组） 和ESD（B 组）治疗，比较两组患者手术时间、治疗费用、病变组织直径、病变组织厚度、肿物完全切除率、 垂直切缘阴性率及并发症发生率等。结果 A 组患者手术时间和治疗费用均明显优于B 组（P <0.05）；两组 患者病变组织直径和厚度比较差异无统计学意义（P >0.05）；B 组患者肿物完全切除率明显高于A 组（P <0.05）； 两组患者垂直切缘阴性率比较差异无统计学意义（P >0.05）；B 组患者并发症发生率明显高于A 组（P <0.05）。 结论 两种内镜术式治疗消化道神经内分泌肿瘤在肿物切除效果方面较为接近，EMR 具有操作时间短、经 济负担轻及并发症少等优势；而ESD 应用则有助于提高肿物彻底清除效果。

Abstract:

Objective To investigate the influence of EMR and ESD of endoscopic surgery on perioperative clinical parameters, complete resection rate and complications of patients with neuroendocrine tumors of digestive tract. Methods 40 patients with neuroendocrine tumors of digestive tract were chosen from June 2009 to June 2016 and randomly divided into 2 groups: A group (20 patients) with EMR and B group (20 patients) with ESD; and the operation time, the treatment cost, the lesion size, the lesion thickness, the complete resection of tumor, the negative rate of vertical margin and the complication incidence of the two groups were compared. Results The operation time and the treatment cost of B group were significant better than A group (P < 0.05). There was no significant difference in the lesion size and the lesion thickness between the two groups (P < 0.05). The completed resection rate of B group were significant higher than A group (P < 0.05). There was no significant difference in the negative rate of vertical margin between the two groups (P < 0.05). The complication incidence of B group were significant higher than A group (P < 0.05). Conclusion EMR and ESD of endoscopic surgery in the treatment of patients with neuroendocrine tumors of digestive tract possess the same clinical effects; EMR application can efficiently shorten the operation time and decrease the economic burden and ESD application maybe helpful to reduce the complication risk.