直肠神经内分泌肿瘤的内镜下诊断与治疗

Endoscopic diagnosis and therapies of rectal neuroendocrine tumors

摘要:

摘要：目的??分析直肠神经内分泌肿瘤（R-NENs）的临床病理学特征，并探讨R-NENs内镜下的诊断特点及内镜下治疗的效果及安全性。方法 回顾性分析2010年1月－2019年9月就诊于新疆医科大学第一附属医院并行常规结肠镜检查的76例R-NENs患者的临床资料，均经组织标本活检或手术切除瘤体病理检查明确诊断为R-NENs。结果 肿瘤位于低位直肠段32例（42.11%），中段25例（32.89%），下段19例（25.00%）。36例行超声内镜（EUS）检查，其中27例EUS下诊断为R-NENs，2例诊断为间质瘤，6例诊断为脂肪瘤，1例诊断为平滑肌瘤，与病理结果诊断符合率达75.00%（27/36）。29例病例行内镜黏膜下剥离术（ESD），22例行内镜下黏膜切除术（EMR），20例行内镜经黏膜下隧道肿物剥离术（STER），2例行电凝电切术，3例因不同原因未通过上述内镜手术方式进行治疗。所有患者中69例行病理学检查及免疫组化检查，结果证实G1级最多见，共62例，占所有病例的81.58%（62/76）。结论 R-NENs以男性多见，好发于中低位直肠段，其中G1级最为常见；EUS技术的成熟运用能够对病变性质及组织学起源进行较准确的判断，但也存在一定的误诊率，最终还应以病理结果为金标准；早期G1、G2级R-NENs经内镜治疗是安全有效的，并且能够提供较完整的病理学资料。

Abstract:

Abstract: Objectives?To analyze the clinicopathological characteristics of rectal neuroendocrine tumors (R-NENs), and evaluate the efficacy and safety of endoscopic diagnosis and treatment of rectal neuroendocrine tumors (R-NENs).?Methods?The clinical data of 76 patients with rectal neuroendocrine tumors (R-NENs) diagnosed by biopsy or surgical resection after colonoscopy from January 2010 to September 2019 were analyzed retrospectively.?Results?The tumors were located in the lower rectal segment in 32 cases (42.11%), the middle segment in 25 cases (32.89%), and the lower segment in 19 cases (25.00%). Of the 36 patients, 27 were diagnosed as rectal neuroendocrine tumors (R-NENs), 2 as stromal tumors, 6 as lipomas, and 1 as leiomyoma. 29 patients underwent endoscopic submucosal dissection (ESD), 22 patients underwent endoscopic submucosal tumor resection (EMR), and 20 patients underwent endoscopic submucosal tunnel tumor resection (STER). The other 2 cases were treated by electrocoagulation and electrocision, and the other 3 cases were not treated by the above endoscopic operation due to different reasons. Among all the patients, 69 were examined by pathology and immunohistochemistry. The results showed that G1 grade was the most common in 62 cases, accounting for 81.58% (62/76) of all these cases.?Conclusion?Most of the rectal neuroendocrine tumors are male, which are prone to occur in the middle and low rectal segments, of which G1 grade is the most common; the mature application of EUS technology can make a more accurate judgment on the nature and histological origin of the lesions, but there are also some misdiagnosis, and the final case result is the gold standard; the early G1 and G2 grade rectal neuroendocrine tumors (R-NENs) are safe and effective after endoscopic treatment. And can provide more complete pathological data.