单环套扎器辅助内镜下黏膜切除术治疗直肠小神经内分泌肿瘤的临床价值

Clinical value of endoscopic mucosal resection with single ring ligation device for treatment of small rectal neuroendocrine tumors

摘要:

目的 评价单环套扎器辅助内镜下黏膜切除术（EMR）对直肠小神经内分泌肿瘤（NETs）的治疗价值。方法 回顾性分析2016年10月－2019年12月在空军军医大学西京医院及西安市人民医院（西安市第四医院）消化内科经单环套扎器辅助EMR治疗的直肠小NETs患者的临床资料。记录病变部位、超声内镜（EUS）下表现、操作时间、病理结果、治疗结果、不良事件以及随访情况。结果 共收集26例患者的26处病变。术前EUS检查结果显示3例病变来源于黏膜肌层，其余23例病变均来源于黏膜下层。26例病变均成功接受单环套扎器辅助EMR治疗，病变中位最长径为6.0 mm（5.0～10.0 mm）；中位操作时间为5.0 min（3.0～13.0 min）；病变完整切除率为100%，1例病变基底可疑残留。术后病理学检查结果显示24例WHO分级为G₁级，2例分级为G₂级；1例患者出现术中出血，2例患者出现术后迟发性出血，给予内镜下电凝止血后出血停止。1例患者存在肌层轻度损伤，无术中及术后穿孔发生。术后平均随访时间为24.7个月（8～36个月），均未出现复发或淋巴结及远处转移。结论 在直肠小NETs的治疗中，使用单环套扎器辅助EMR操作简单省时，费用较低，是安全有效的微创治疗方法。

Abstract:

Objective To evaluate the clinical effect of single band ligation-assisted endoscopic mucosal resection (SBL-EMR) for treatment of small rectal neuroendocrine tumors (NETs).Methods A retrospective study was performed on data of patients with small NETs who treated by SBL-EMR from October 2016 to December 2019. The location of lesion, manifestations of EUS, procedure time, pathology, treatment outcomes, adverse events and follow-up results were recorded.Results 26 lesions in 26 patients were enrolled in our study. EUS results showed that 3 lesions originated from muscularis mucosa and 23 lesions from submucosa layer. All the 26 lesions were successfully treated by SBL-EMR. The mean maximum diameter of the lesions was 6.0 mm (5.0～10.0 mm), and the mean procedure time was 5.0 min (3.0～13.0 min). The complete resection rate was 100%. There was 1 patient with suspicious positive basal surgical margin. Histological examination determined that 24 lesions were pathologic grade 1 (G₁) and 2 lesions were pathologic grade 2 (G₂). Intra-procedure and delayed bleeding occurred in 1 and 2 cases, which were successfully treated by endoscopy. Intra-procedure muscular injury was observed in 1 patient and no perforation occurred. During a mean follow-up period of 24.7 months, no lymph node metastasis or distant metastasis was observed, and no recurrence of the tumor was found.Conclusion Single band ligation-assisted endoscopic mucosal resection may be a simple, safe, efficient and cost-effective method for resecting of small rectal NETs.