内镜下不同方法治疗直肠神经内分泌肿瘤的疗效分析

Efficacy analysis of different endoscopic treatments for rectal neuroendocrine neoplasms

摘要:

目的 探讨内镜下不同方法治疗直肠神经内分泌肿瘤（NEN）的疗效。方法 回顾性分析2014年1月－2020年1月该院86例经肠镜白光及活检病理判断为直肠NEN患者的临床资料。其中，23例采用内镜下黏膜切除术（EMR），49例采用内镜黏膜下剥离术（ESD），14例采用内镜全层切除术（EFR）；记录并评估3组患者病灶大小、切除面积、术前超声深度、手术时间、病灶切除大小、住院时间、一次性整块切除率、一次性R0切除率、侧切缘及基底切缘阳性率、并发出血、穿孔发生率和3年生存率等情况。结果 EMR组、ESD组及EFR组病变切除面积中位数分别为100.00、240.00及320.00 mm2，呈明显递增趋势（P < 0.05）；手术时间分别为（20.04±6.44）、（46.35±8.76）和（54.21±7.65）min，明显延长（P < 0.05）；术后住院时间分别为（2.17±0.42）、（4.40±0.90）和（5.07±0.68）d，明显增加（P < 0.05）。而病变R0切除率、血管浸润率、淋巴管浸润率、神经侵犯率、垂直切缘阳性率、CD56表达率、嗜铬粒蛋白A（CgA）表达率和术后并发症发生率比较，差异均无统计学意义（P > 0.05）。结论 对于位于直肠的、无淋巴结转移的、直径小于10 mm的直肠NEN，可通过EMR、ESD及EFR安全切除。其中，EMR相对简单，手术时间明显短于ESD及EFR；EFR具有较高的整体切除率和组织学切除率，可能优于传统的EMR及ESD，但手术时间明显长于ESD和EMR，3种方法在R0切除率、术后并发症发生率及生存率上并无较大区别。

Abstract:

Objective To study the therapeutic effect of rectal neuroendocrine neoplasm (NEN) under different endoscopy surgeries.Methods From January 2014 to January 2020, 86 patients diagnosed as rectal NEN by white light enteroscopy and pathological biopsy were collected for retrospective clinical analysis. Among them, 23 patients were resected by endoscopic mucosal resection (EMR), 49 patients by endoscopic submucosal dissection (ESD), and 14 patients by endoscopic full thickness resection (EFR). The size of lesion, resection area, preoperative ultrasound depth, duration of surgery, resection size of lesion, length of hospital stay, one-time lump-resection rate, one-time R0 complete resection rate, positive rate of lateral resection margin and basal resection margin, incidence of concurrent bleeding and perforation, and 3-year survival rate were recorded and evaluated in 3 groups.Results The lesion resection area of EMR group, ESD group and EFR group (100.00 mm2, 240.00 mm2 and 320.00 mm2, P < 0.05)significantly increased. Operation time [(20.04 ± 6.44) min, (46.35 ± 8.76) min and (54.21 ± 7.65) min, P < 0.05] significantly increased. The postoperative hospital stay [(2.17 ± 0.42) d, (4.40 ± 0.90) d and (5.07 ± 0.68) d, P < 0.05] significantly increased. However, there were no significant differences in R0 resection, vascular infiltration, lymphatic infiltration, nerve invasion, vertical resection margin, CD56 expression, CgA expression and postoperative complications (P > 0.05).Conclusion For NEN patients with no lymph node metastasis less than 10 mm in diameter located in rectum, it can be safely resected by endoscopy. The resection methods can be EMR, ESD and EFR. EMR is relatively simple, and the operation time and postoperative hospital stay are significantly shorter than ESD and EFR. EFR has a successful overall resection and histological resection rate, which may be superior to traditional EMR and ESD, but the operation time and postoperative hospital stay are significantly higher than ESD and EMR. However, there is no significant difference in the curative resection (R0 resection), postoperative complications and follow-up survival rate among the three methods.