内镜全层切除术和内镜黏膜下剥离术治疗直肠神经内分泌肿瘤的疗效比较

Comparison between endoscopic full thickness resection and endoscopic submucosal dissection in treatment of rectal neuroendocrine neoplasms

摘要:

目的 比较内镜全层切除术（EFR）和内镜黏膜下剥离术（ESD）治疗直肠神经内分泌肿瘤（NENs）的有效性和安全性。方法 回顾性分析2016年1月－2021年6月因直肠NENs（ < 2.0 cm）在该院行EFR或ESD治疗的90例患者的临床资料。根据治疗方法不同，分为EFR组和ESD组，比较两组的操作时间、术后住院时间、并发症（出血、穿孔和感染）和完整切除率等指标。结果 两种治疗方法术后住院时间比较，差异无统计学意义（P > 0.05）。EFR组完整切除率高于ESD组（100.00%和84.91%），差异有统计学意义（P < 0.05）。EFR组中位操作时间短于ESD组（10.00和20.00 min），差异有统计学意义（P < 0.05）。EFR组无不良事件发生，ESD组1例发生术后出血，经内镜下止血治疗后好转出院。结论 EFR治疗 < 2.0 cm的直肠NENs安全有效，相较于ESD，其完整切除率高，操作时间短，并发症少，且两种手术方法术后住院时间并无差别。EFR治疗 < 2.0 cm的直肠NENs值得临床推广应用。

Abstract:

Objective To Compare the efficacy and safety of endoscopic full thickness resection (EFR) and endoscopic submucosal dissection (ESD) in treatment of rectal neuroendocrine neoplasms (NENs).Methods From January 2016 to June 2021, the clinical data of 90 patients with rectal NENs ( < 2.0 cm) removed by EFR or ESD were analyzed retrospectively. According to different treatment methods, the patients were divided into EFR group and ESD group. The procedure time, postoperative hospital stay, complications (bleeding, perforation and infection) and complete resection rate were summarized.Results There was no significant difference in postoperative hospital stay between the two groups (P > 0.05). The complete resection in EFR group was higher than ESD group (100.00% vs 84.91%), the difference was statistically significant (P < 0.05). The median procedure time in EFR group was shorter than ESD group (10.00 vs 20.00 min), the difference was statistically significant (P < 0.05). There was no adverse event in the EFR group, one bleeding in group ESD was halted with endoscope.Conclusion EFR is a safe and effective technique when removing rectal NENs ( < 2.0 cm). Compared with ESD, EFR has higher complete resection rate, shorter procedure time, fewer complication, and there is no significant difference in the duration of postoperative hospital stay between the two groups. EFR treatment of rectal NENs < 2.0 cm is worthy of clinical application.