内镜与外科手术治疗直肠小神经内分泌肿瘤的回顾性对比研究  

A comparative study on endoscopic and surgical treatment of small rectal neuroendocrinal tumor

作　　者：高东锋[1] 吕文浩[1] 张林慧[1] 黄蕊[1] 姚少维[1] 刘志国[1] 吴开春[1] 

机构地区：[1]第四军医大学西京医院消化内科,西安710032

出　　处：《中华消化内镜杂志》2016年第7期447-450,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨内镜切除与外科经腹腔镜辅助或经肛入路切除直肠神经内分泌肿瘤的差异。方法回顾性分析2010年12月至2013年11月问经内镜下或外科手术切除直径〈2cm、经术后病理证实为神经内分泌肿瘤患者的相关临床资料。结果内镜下治疗共纳入20例患者，其中17例ESD切除，3例EMR切除；外科治疗共纳入18例，其中12例经肛手术、6例经腹腔镜切除。内镜组病变大小为7mm（4-18mm），外科组为8mm（3～15mm）。术后病理提示除外科组2例分级为G2外，均为G1。内镜组切除均提示水平切缘阴性，无脉管侵犯，外科3例可见脉管及淋巴结侵犯。内镜组及外科组术后均未发生严重不良事件。内镜组术后恢复饮食时间为2．0d（1-4d），外科2．4d（1-7d）（P=0．295）；住院时间分别（6．80±2．12）d和（8．59±2．85）d（P=0．034）；内镜组总住院费用平均10488（4128～15296）元，外科组住院花费平均15590（3024～40503）元（P=0．031）。术后随访时间25个月（2～48个月），复查均无复发。结论内镜下切除，特别是ESD，是治疗直肠神经内分泌肿瘤的新方法，较外科手术有住院时间短、手术创伤小、手术时间短、术中出血少、并发症少及节约费用等优点。Objective To compare the differences between endoscopic resection and laparoscopy- assisted surgery or transanal endoscopic resection for rectal neuroendocrinal tumor. Methods Clinical data of patients who underwent endoscopic or surgical resection of neuroendocrinal tumor of less than 2 cm which were confirmed by pathology from December 2010 to November 2013 were retrospectively analyzed. Results Twenty cases of endoscopic treatment, including 17 cases of ESD, 3 cases of EMR,were included in endoscopy group; while 18 cases treated with surgery- were included in surgery group, among which 12 ca- ses underwent transanal endoscopic microsurgery and 6 cases laparoscopic resection. The mean lesion sizes were 7 mm（4-18 ram）and 8 mm（3-15 mm）, respectively. Pathology showed there were 16 cases of grade G1 neurocrinal tumor and 2 G2 cases in surgical group. There was no lymphvascular invasion with clear margin in the endoscopy group, but three cases of lymphvascular invasion in surgical group. No treatment-related se- vere adverse event occurred in either group. The time for oral food intake was 2. 0 d （ 1-4 d） in endoscopy group, while that in surgeI3＇ group was 2. 4 d（ 1-7 d）（P=0. 295）. The hospital stay was（6. 80±2. 12） d in endoscopy group and （8.59±2. 85 ）d in surgery group, respectively （P = 0. 034）. And the total hospitalization cost was 10 488（4 128-15 296） yuan and 15 590（3 024-40 503） yuan（P=0. 031） in the two groups, re- spectively. The follow-up was 25 months （ 2-48 months） and no recurrence was found. Conclusion Endo- scopic resection, especially ESD, is a new approach to treat eoloreetal neuroendocrinal tumor, advantageous over surgery in shorter hospitalization time, minimal invasiveness, faster postoperative recovery, less compli-cation, and reduced hospitalization cost.

关 键 词：直肠 神经内分泌瘤 腹腔镜 外科手术 内镜黏膜下剥离术 

分 类 号：R735.37[医药卫生—肿瘤]