内镜下全层切除术治疗直肠神经内分泌肿瘤的临床疗效

Clinical efficacy of endoscopic full-thickness resection of rectal neuroendocrine tumors

摘要:

目的 探讨内镜下全层切除术（EFR）在直肠神经内分泌肿瘤（NET）中的应用效果。方法 回顾性分析2016年4月－2018年4月在该院消化科行内镜治疗的NET患者的临床资料，按手术方式不同分为观察组（EFR组，n = 22）和对照组［内镜下黏膜剥离术（ESD）组，n = 18］。EFR组行EFR治疗，ESD组行传统ESD。分析手术过程、肿瘤学特征、并发症、住院时长和标本病理等。结果 EFR组与ESD组比较，性别、年龄、肿瘤部位及大小、病变类型等差异无统计学意义（P > 0.05）。EFR组完整切除率为100.0%，ESD组为88.9%；EFR组手术时间为（32.8±12.4）min，ESD组为（54.3±13.5）min，EFR组明显较ESD组短，差异有统计学意义（P < 0.05）；两组患者术后并发症和术后住院时间比较，差异无统计学意义（P > 0.05）。ESD组2例基底切缘阳性，2例因灼伤，基底切缘难以判定，EFR组中基底切缘均阴性，两组比较，差异有统计学意义（P < 0.05）。结论 采用EFR治疗小于2.0 cm的G₁～G₂级直肠NET，安全、有效，与传统的ESD手术方式比较，缩短了手术时间，提高了完整切除率，且不受肿瘤部位的限制，值得临床推广应用。

Abstract:

Objective To investigate the application effect of endoscopic full-thickness resection (EFR) in patients with rectal neuroendocrine tumor (NET).Methods The patients with NET who underwent endoscopic treatment from April 2016 to April 2018 were retrospectively analyzed. They were divided into observation group (EFR group, n = 22) and control group (ESD group, n = 18). The EFR group underwent endoscopic full-thickness resection, and the ESD group underwent traditional endoscopic mucosal dissection. The operation process, oncological characteristics, complications, length of hospital stay, specimen pathology and so on were analyzed.Results There was no significant difference in gender, age, tumor location, size and lesion type between EFR group and ESD group (P > 0.05). The complete resection rate was 100.0% in EFR group and 88.9% in ESD group; The operation time in EFR group was (32.8 ± 12.4) min and that in ESD group was (54.3 ± 13.5) min. the operation time in EFR group was significantly shorter than that in ESD group (P < 0.05); There was no significant difference in postoperative complications and postoperative hospital stay between the two groups (P > 0.05). The basal margin was positive in 2 cases in ESD group and difficult to determine in 2 cases due to burn. The basal margin was negative in EFR group. There was significant difference between the two groups (P < 0.05).Conclusion EFR is a safe and effective minimally invasive surgery for rectal cancer with a diameter of less than 2.0 cm and a grade of G₁ and G₂. Compared with the traditional ESD surgery, it can shorten the operation time, significantly improve the complete resection rate, and is not limited by the tumor location. It is worthy of clinical application.