内镜黏膜下剥离术治疗Ⅰ型胃神经内分泌肿瘤的安全性、有效性分析  

Safety and efficacy of endoscopic submucosal dissection in the treatment of typeⅠ gastric neuroendocrine tumors

作　　者：聂锦山[1] 刘歆阳 郜娉婷 蔡贤黎 李全林 周平红 NIE Jinshan;LIU Xinyang;GAO Pingting;CAI Xianli;LI Quanlin;ZHOU Pinghong(Department of Gastroenterology,Taicang Hospital Affiliated to Scoochow University,Taicang 215400;Endoscopy Center and Endoscopy Research Institute,Zhongshan Hospital,Fudan University,China)

机构地区：[1]苏州大学附属太仓医院消化内科,江苏太仓215400 [2]复旦大学附属中山医院内镜中心

出　　处：《胃肠病学和肝病学杂志》2022年第2期182-186,共5页Chinese Journal of Gastroenterology and Hepatology

基　　金：苏州市卫生青年骨干人才“全国导师制”培训项目[苏卫计科教(2018)11号]。

摘　　要：目的探究内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗Ⅰ型胃神经内分泌肿瘤(gastric neuroendocrine tumors,GNETs)的安全性及有效性。方法回顾性分析2012年1月至2018年12月接受ESD治疗并病理确诊的Ⅰ型GNETs患者,收集临床及病理资料进行分析,门诊及电话随访术后情况。结果共纳入61例Ⅰ型GNETs病例,总病灶数143个,多发病灶2~5个36例(59.0%),病灶≥6个5例(8.2%)。病灶分布在胃体128个(89.5%),胃底10个(7.0%),胃窦5个(3.5%)。所有病变均为整块切除(100%),病灶直径平均为7.9 mm(4~30 mm),115个病灶(80.4%)直径<10 mm,病灶直径>20 mm 4例(2.8%)。ESD平均手术时间为19 min(10~60 min),全组病例未出现术中和术后穿孔、出血等并发症。ESD术后病理显示G_(1)级99个(69.2%)病灶,G_(2)级44个(30.8%)病灶。2例病灶垂直切缘阳性,完整切除率98.6%(141/143),1例切缘阳性患者追加补救性外科手术。术后中位随访38.3个月(10~93个月),1例患者意外死亡,死因与GNETs无关。随访中无患者出现原位复发。10例患者ESD术后异位再发,再发率为16.4%(10/61),中位再发时间为12.8个月。再发病例中,有6例G_(1)级和1例G_(2)级患者再次接受ESD治疗;2例G_(1)级患者拒绝再次手术,密切随访;1例G_(2)级患者发现复发后意外死亡。5例患者病灶数目≥6个,其中4例G_(1)级,1例G_(2)级,ESD术后均密切随访,异位再发率40.0%(2/5)。4例患者病灶直径>20 mm,其中1例G_(2)级病例为前述因切缘阳性追加补救性外科手术;其余3例术后病理评估为1例G_(1)级,2例G_(2)级,水平切缘和垂直切缘均阴性、无脉管侵犯,随访无原位复发或异位再发。结论ESD是Ⅰ型GNETs安全、有效的治疗选择。Objective To investigate the safety and efficacy of endoscopic submucosal dissection(ESD)in the treatment of type I gastric neuroendocrine tumors(GNETs).Methods From Jan.2012 to Dec.2018,the patients with typeⅠGNETs who received ESD treatment and confirmed pathologically were included in the retrospective study.The clinical and pathological data were collected for analysis,and the postoperative recovery were followed up through outpatient and telephone.Results 61 cases of typeⅠGNETs were included.The total number of lesions was 143.36 cases(59.0%)had multiple lesions(2-5 lesions),and 5 cases(8.2%)had more than 6 lesions.There were 128 lesions(89.5%),10 lesions(7.0%)and 5 lesions(3.5%)distributed in gastric bodies,fundus and antrum,respectively.All lesions(100%)were excised in en bloc,the average diameter of lesions was 7.9 mm(4-30 mm),where 115 lesions(80.4%)were less than 10 mm,and 4 lesions(2.8%)were more than 20 mm.The average ESD operation time was 19 minutes(10-60 minutes).There were no intraoperative and postoperative complications such as perforation and bleeding in all cases.The ESD postoperative pathology showed that 99 lesions(69.2%)were found in grade G_(1) and 44 lesions(30.8%)in grade G_(2).The complete resection rate of two cases with positive margin was 98.6%(141/143),and 1 case with positive margin appended remedial surgery.The median follow-up lasted 38.3 months(10-93 months)and found that 1 patient died unexpectedly,and the cause of death was not related to GNETs.There was no recurrence in situ during the follow-up.Ectopic recurrence occurred in 10 patients after ESD.The recurrence rate was 16.4%(10/61).The median recurrence time was 12.8 months.Among the patients with reoccurrence,6 patients with grade G_(1) and 1 patient with grade G_(2) received ESD treatment again.2 patients with grade G_(1) refused to reoperate and were followed up closely.1 patient with grade G_(2) recurred after operation,but died unexpectedly.The lesions were more than 6 in 5 cases,including 4 cases of grade G_(1) an

关 键 词：内镜黏膜下剥离术 胃神经内分泌肿瘤 安全性 有效性 

分 类 号：R735.2[医药卫生—肿瘤]