直肠神经内分泌肿瘤ESD的治疗效果及不完整切除影响因素  

Therapeutic Effect of ESD in Rectal Neuroendocrine Tumors andInfluencing Factors of Incomplete Resection

作　　者：青泓屹 魏寿江[1] 李勋[1] QING Hongyi;WEI Shoujiang;LI Xun(Affiliated Hospital of North Sichuan Medical College,Sichuan Nanchong 637000,China)

机构地区：[1]川北医学院附属医院胃肠外一科,四川南充637000

出　　处：《河北医学》2020年第5期854-858,共5页Hebei Medicine

基　　金：四川省卫计委科研项目,(编号:17PJ104)。

摘　　要：目的:探究直肠神经内分泌肿瘤行内镜黏膜下剥离术(ESD)治疗的效果,分析不完整切除的影响因素。方法:选取2016年4月至2019年4月本院收治的直肠神经内分泌肿瘤患者120例,均行ESD治疗,观察ESD手术切除情况、并发症;根据ESD手术切除情况分为完整切除组、不完整切除组,采用单因素及多因素Logistic回归法分析影响ESD不完整切除的相关因素。结果:患者ESD手术时间32~68min,平均(45.28±6.93)min;120例ESD均完成整块切除(100%),完整切除101例(84.17%),不完整切除19例(15.83%);患者术中、术后无穿孔、出血等并发症;随访6~12个月,平均(1.95±0.39)年,无失访病例,随访期间无复发、转移。单因素分析显示,肿瘤直径、浸润深度、病变表面黏膜中央凹陷与直肠神经内分泌肿瘤患者ESD不完整切除有关(P<0.05),而与性别、年龄、嗜铬素(CGA)、隆起形态等无关(P>0.05)。进一步多因素Logistic回归分析显示,浸润至黏膜下层(OR=7.179,95%CI=1.206~42.748)、肿瘤直径>1.5cm(OR=15.709,95%CI=2.162~114.126)、病变表面黏膜中央有凹陷(OR=18.191,95%CI=4.063~81.456)是影响直肠神经内分泌肿瘤患者ESD不完整切除的危险因素(P<0.05)。结论:ESD治疗直肠神经内分泌肿瘤安全有效;浸润至黏膜下层、肿瘤直径>1.5cm、病变表面黏膜中央有凹陷的直肠神经内分泌肿瘤患者ESD不完整切除的危险性高。Objective:To investigate the effect of endoscopic submucosal dissection(ESD)on rectal neuroendocrine tumors and to analyze the influencing factors of incomplete resection.Methods:120 patients with rectal neuroendocrine tumors admitted to our hospital from April 2016 to April 2019 were treated with ESD.The resection and complications of ESD were observed.According to the resection of ESD,the patients were divided into complete resection group and incomplete resection group.In the groups,single factor and multivariate logistic regression were taken to analyze the related factors affecting the incomplete resection of ESD.Results:The patient's ESD operation time was 32~68min,with an average of(45.28±6.93)min.120 cases of ESD completed complete resection(100%),complete resection of 101 cases(84.17%),and incomplete resection of 19 cases(15.83%).There were no complications such as perforation and hemorrhage during and after operation.The patients were followed up for 6 months to 12 months,with an average of(1.95±0.39)years.There were no lost cases of follow-up and no recurrence or metastasis appeared during the follow-up period.Univariate analysis showed that tumor diameter,depth of invasion,central depression of lesion surface mucosa were associated with incomplete resection of ESD in patients with rectal neuroendocrine tumors(P<0.05),but not with gender,age,chromogranin(CGA),bulging morphology,etc.(P>0.05).Further multivariate logistic regression analysis showed infiltration to the submucosa(OR=7.179,95%CI=1.206~42.748),tumor diameter>1.5cm(OR=15.709,95%CI=2.162~114.126),and a central mucosal surface of the lesion with a depression(OR=18.191,95%CI=4.063~81.456)were risk factors for incomplete resection of ESD in patients with rectal neuroendocrine tumors(P<0.05).Conclusion:ESD is safe and effective in the treatment of rectal neuroendocrine tumors;patients with rectal neuroendocrine tumors infiltrating into the submucosa,tumor diameter>1.5cm,and a central mucosal surface of the lesion with a depression have a high ri

关 键 词：直肠神经内分泌肿瘤 内镜黏膜下剥离术 不完整切除 影响因素 

分 类 号：R735.37[医药卫生—肿瘤]