39例胃肠神经内分泌肿瘤经内镜黏膜下剥离术的治疗效果评价  

Analysis of 39 cases of gastrointestinal neuroendocrine neoplasms and evaluation of the efficacy of endoscopic submucosal dissection

作　　者：李变霞 陈鑫[1] 郑忠青[1] 王涛[1] 张玉洁[1] 李姝[1] 朱兰平 马双 王邦茂[1] Bianxia Li;Xin Chen;Zhongqing Zheng;Tao Wang;Yujie Zhang;Shu Li;Lanping Zhu;Shuang Ma;Bangmao Wang(Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, Chin)

机构地区：[1]天津医科大学总医院消化科,天津市300052

出　　处：《中国肿瘤临床》2018年第12期623-627,共5页Chinese Journal of Clinical Oncology

基　　金：天津市科技计划项目基金(编号:15ZXJZSY00020)资助~~

摘　　要：目的:探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗胃肠神经内分泌肿瘤(gastrointestinal neuroendo-crine neoplasms,GI-NENs)的安全性及临床有效性。方法:回顾性分析2009年10月至2017年10月天津医科大学总医院收治的39例经ESD治疗GI-NENs患者临床及病理特征、ESD治疗效果、并发症及术后随访结果。结果:39例GI-NENs均为神经内分泌瘤(neuroendocrine tumors,NETs),根据病理组织学和增殖活性分级:G1 37例、G2 2例、G3 0例,其中直肠23例,胃12例,十二指肠4例;35例病变侵及黏膜层或黏膜下层,4例病变侵及固有肌层,ESD术中穿孔1例,出血2例。术后随访6~90个月,仅1例胃神经内分泌瘤(gastric neuroendocrine tumors,g-NETs)患者于术后5个月及34个月在胃内不同部位分别形成新的病变,随后均再次行ESD治疗并追踪随访。39例患者均未出现淋巴结和远处转移,生存率为100%。结论:对于无淋巴结及远处转移的GI-NENs,病变局限于黏膜下层且直径≤1.0 cm是ESD绝对适应证;对于未侵及固有肌层且直径为1.0~1.5 cm的直肠NENs或1型胃神经内分泌瘤(Type 1 gastric neuroendocrine tumours,T1-GNETs)T2患者,应优先考虑ESD治疗,以保留胃肠容积及功能。To investigate the safety and clinical efficacy of endoscopic submucosal dissection（ESD） in the treatment of gastrointestinal neuroendocrine neoplasms（GI-NENs）. Methods： The clinical and pathological features of 39 patients with GI-NENs who were treated with ESD, the efficacy of ESD treatment, complications, and follow-up results were analyzed retrospectively. Results： The 39 cases of GI-NENs were all neuroendocrine tumors（NETs）. According to histopathology and proliferative activity, there were 37 cases of G1, two cases of G2, and no cases of G3, including 23 cases of cancer in the rectum, 12 in the stomach, 4 in the duodenum. Thirty-five lesions invaded the mucosa or submucosa, four invaded the muscularis propria, one perforated in the ESD, and two were associated with bleeding. After 6 to 90 months of follow-up, new lesions were found in 1 patient with g-NETs in different parts of the stomach at 5 and34 months after operation, followed by ESD treatment and further follow-up. No lymph node and distant metastases were found, and the survival rate of the patients was 100%. Conclusions： For GI-NENs without lymph node and distant metastases, the lesion is confined to the submucosa, and a diameter ≤1.0 cm is an absolute indication of ESD. For rectal neuroendocrine neoplasms that have noninvasive muscularis propria with diameters between 1 and 1.5 cm, or for patients with Type 1 gastric neuroendocrine tumors（T1-GNETs） that are predicted to be T2, ESD treatment should be prioritized to preserve gastrointestinal volume and function.

关 键 词：胃肠神经内分泌肿瘤 内镜黏膜下剥离术 适应证 预后 

分 类 号：R735[医药卫生—肿瘤]