环周预切开内镜黏膜切除术治疗直径小于1 cm的直肠神经内分泌肿瘤的有效性和安全性

The effectiveness and safety of endoscopic mucosal resection with precutting for rectal neuroendocrine neoplasm smaller than 1 cm in diameter

摘要:

目的 探讨环周预切开内镜黏膜切除术（EMR-P）治疗直径小于1 cm的直肠神经内分泌肿瘤（RNEN）的有效性和安全性。方法 回顾性分析2016年12月－2021年12月该院收治的177例直径 < 1 cm的RNEN患者的临床资料，根据治疗方案的不同，将患者分为内镜黏膜切除术（EMR）组（n = 46）、EMR-P组（n = 40）和内镜黏膜下剥离术（ESD）组（n = 91），比较3组患者整块切除率、完整切除率、内镜下手术时间、术后住院时间和手术并发症等情况。结果 EMR-P组完整切除率为95.0%，ESD组完整切除率为97.8%，高于EMR组的87.0%，差异有统计学意义（P < 0.05）；EMR-P组手术时间为（9.86±2.23）min，长于EMR组的（4.12±0.88）min，EMR-P组和EMR组手术时间短于ESD组的（19.55±3.67）min，差异均有统计学意义（P < 0.05）；EMR组住院时间为（2.45±0.29）d，EMR-P组住院时间为（2.43±0.23）d，EMR-P组和EMR组住院时间短于ESD组的（3.30±0.32）d，差异均有统计学意义（P < 0.05）；3组患者整块切除率和并发症发生率比较，差异均无统计学意义（P > 0.05）。结论 EMR-P用于治疗直径 < 1 cm的RNEN，操作简单，手术时间和住院时间短，且组织学完整切除率高，并发症发生率低，值得临床应用。

Abstract:

Objective To investigate the effectiveness and safety of endoscopic mucosal resection with precutting (EMR-P) for the treatment of rectal neuroendocrine neoplasm (RNEN) smaller than 1 cm in diameter.Methods Clinical data of 177 patients with RNEN smaller than 1 cm in diameter from December 2016 to December 2021 were retrospectively analyzed. According to different treatment protocols, 177 patients with RNEN were divided into endoscopic mucosal resection (EMR) group (n = 46), EMR-P group (n = 40) and endoscopic submucosal dissection (ESD) group (n = 91). The en bloc resection rate, complete resection rate, operation time, postoperative hospitalization time and incidence of operative complications among the three groups were compared.Results The complete resection rate in the EMR-P group (95.0%) and ESD group (97.8%) were significantly higher than that in the EMR group (87.0%) (P < 0.05); The operation time in the EMR-P group (9.86 ± 2.23) min was longer than that in the EMR group (4.12 ± 0.88) min, EMR-P group and EMR group were shorter than that in the ESD group (19.55 ± 3.67) min, the difference was statistically significant (P < 0.05); Postoperative hospitalization time in the EMR group was (2.45 ± 0.29) d and EMR-P group was (2.43 ± 0.23) d, which were shorter than that in the ESD group (3.30 ± 0.32) d, and the difference was statistically significant (P < 0.05). There were no significant difference in the rates of en bloc resection and operative complications among the three groups (P > 0.05).Conclusion EMR-P for the treatment of RNEN < 1 cm in diameter has the advantages, such as simple operation, short operation time and hospitalization time, high histological complete resection rate and low complication rate, which is worthy of clinical application.