内镜黏膜下剥离术治疗前肠神经内分泌肿瘤临床价值评价  

Endoscopic submucosal dissection for the treatment of foregut neuroendocrine tumors

作　　者：李全林[1] 姚礼庆[1] 徐美东[1] 张轶群[1] 钟芸诗[1] 陈巍峰[1] 马丽黎[1] 秦文政[1] 周平红[1] 

机构地区：[1]复旦大学附属中山医院内镜中心上海消化内镜诊疗工程技术研究中心,上海200032

出　　处：《中国实用外科杂志》2014年第6期532-536,共5页Chinese Journal of Practical Surgery

基　　金：上海市科委重大课题(11411950502;13411950801);国家自然科学基金(81302098;81201902);上海市卫计委学科带头人培养计划(13B038)

摘　　要：目的评价内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)在前肠神经内分泌肿瘤(neuroendocrine neoplasm,NENs)治疗中的安全性及有效性。方法回顾性分析2008年4月至2010年12月复旦大学附属中山医院内镜中心采用ESD治疗的24例前肠NENs病人资料。详细记录病变的临床病理特征,完整切除率,增殖活性分级,并发症发生率以及有无局部复发或远处转移等资料。结果 24例病人中29例次病变接受了ESD治疗,包括食管病变1例次,贲门病变1例次,胃病变23例次和十二指肠病变4例次。所有病变均一次性整块切除,病灶的平均直径为9.4(2～30)mm,平均手术时间20.3(10～45)min。根据2010年WHO分类标准,26例次病变为神经内分泌瘤(NET)-G1,2例次胃病变为NET-G2,1例次食管病变为神经内分泌癌(NEC)。28例次病变完整切除,完整切除率96.6%。1例次未完整切除的食管NEC病人接受了外科手术治疗。术后迟发性出血1例次,通过内镜下处理及保守治疗好转。所有病人均接受随访,平均随访时间24.4(12～48)个月;1例次病人出现局部复发并接受了再次ESD治疗;无淋巴结或远处转移病例。结论在前肠NENs治疗中,ESD是一种安全且有效的治疗手段,不仅可提供准确的病理学评估,又可达到根治目的。Objective To evaluate the feasibility and efficacy of endoscopic submucosal dissection （ESD） for foregut neuroendocrine neoplasm（NENs）. Methods A total of 24 patients with confirmed histological diagnosis of foregut NENs performed ESD from April 2008 to December 2010 in Zhongshan Hospital of Fudan University were included. Tumor features, clinicopathological characteristics, complete resection rate, complications and fallow-up results were evaluated. Results Those treated by ESD included 24 patients with 29 foregut NENs. The locations of the 29 lesions were as follows： esophagus （n=l）, cardia （n=l）, stomach （n=23）, and duodenal bulb （n=4）. All of the tumors were removed in an en bloc fashion. The average maximum diameter of the lesions was 9.4 mm （range 2-30 mm）, and the procedure time was 20.3 min （range 10-45 min）. According to the World Health Organization 2010 classification, histological evaluation determined that 26 lesions were NET-G1, 2 gastric lesions were NET-G2, and 1 esophageal lesion was neuroendocrine carcinoma （NEC）. Complete resection was achieved in 28 lesions （28/29, 96.6%）. The remaining patient with NEC underwent additional surgery because of incomplete resection. Delayed bleeding occurred in 1 case after ESD, which was managed by endoscopic treatment. During a mean follow-up period of 24.4 months （12-48 months）, local recurrence occurred in only 1 patient after initial ESD. The patient underwent repeat ESD successfully. Metastasis to lymph nodes or distal organs was not observed in any patient. Conclusion ESD appears to be a safe, feasible and effective procedure for providing accurate histopathological evaluations as well as curative treatments for eligible foregut NENs.

关 键 词：内镜黏膜下剥离术 神经内分泌肿瘤 前肠 

分 类 号：R6[医药卫生—外科学]