小探头超声内镜在不同起源层次直肠神经内分泌肿瘤诊断与治疗中的价值  

Evaluation of miniprobe endoscopic ultrasonography for the diagnosis and treatment of rectal neuroendocrine neoplasms of different origin

作　　者：周卫真[1] 李光[1] 高茹[1] 刘晓 高颖新[1] 郝建宇[1] 刘心娟[1] Zhou Weizhen;Li Guang;Gao Ru;Liu Xiao;Gao Yingxin;Hao Jianyu;Liu Xinjuan(Department of Gastroenterology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院消化内科,北京100020

出　　处：《中华消化内镜杂志》2022年第6期479-483,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨不同起源层次的直肠神经内分泌肿瘤(rectal neuroendocrine neoplasm,R-NENs)的超声内镜下特点及对诊断和治疗决策的影响。方法采用回顾性横断面研究,收集2016年1月—2021年7月在首都医科大学附属北京朝阳医院消化内镜中心行小探头超声内镜检查(miniprobe endoscopic ultrasonography,MEUS),经MEUS或病理诊断为R-NENs的病例共56例,比较黏膜深层起源与黏膜下层起源的R-NENs的超声内镜下表现、病理分级、治疗方式和随访结果。结果56例中,49例确诊为R-NENs,MEUS诊断R-NENs的敏感度为93.88%(46/49),阳性预测值为86.79%(46/53),准确率为82.14%(46/56)。R-NENs主要表现为中低回声[95.92%(47/49)]。被漏诊的3例R-NENs均起源于黏膜下层,1例表现为低回声、2例表现为高回声。黏膜深层起源与黏膜下层起源R-NENs比较,两者在肿瘤长径、超声内镜下回声强度、回声均匀度和病理分级构成方面差异均无统计学意义(P均>0.05),但两者在肿瘤距肛门距离构成方面差异有统计学意义(χ^(2)=5.011,P=0.025),黏膜下层起源者肿瘤距肛门距离≤5 cm占比较黏膜深层起源者有大幅上升[43.75%(14/32)比17.65%(3/17)]。治疗方式上以内镜黏膜下剥离术[67.5%(27/40)]和外科经肛门内镜下直肠病变微创手术[25.0%(10/40)]为主,但不同术式间R-NENs的超声内镜下表现和病理分级构成并无明显差别。结论对于黏膜深层起源与黏膜下层起源的R-NENs,超声内镜下表现和病理分级并无明显差别,可能提示两者的预后相当。至于不同起源层次R-NENs的超声内镜下表现,暂未发现其对治疗方式选择产生明显影响。Objective To investigate the characteristics of endoscopic ultrasonography for rectal neuroendocrine neoplasms(R-NENs)of different origin and its influence on the diagnosis and treatment.Methods A retrospective cross-sectional study was conducted to analyze 56 cases of R-NENs diagnosed by miniprobe endoscopic ultrasonography(MEUS)and/or pathology in the Endoscopy Center of Beijing Chaoyang Hospital,Capital Medical University from January 2016 to July 2021.The endoscopic ultrasonography characteristics,pathological features,surgical selection and the follow-up of R-NENs originating from deep mucosa and submucosa were compared.Results Among the 56 patients,49 were diagnosed as R-NENs.The diagnostic sensitivity,positive predictive value and diagnostic accuracy of MEUS for R-NENs were 93.88%(46/49),86.79%(46/53)and 82.14%(46/56),respectively.R-NENs were mainly manifested by medium hypoechoic with MEUS[95.92%(47/49)].Three R-NENs originated from submucosa were missed diagnosis,with 1 case presenting hypoechoic and 2 cases presenting hyperechoic.There were no significant differences in the tumor diameter,echo intensity under endoscopic ultrasonography,echo uniformity and pathological grade composition between deep mucosal origin and submucosal origin R-NENS(all P>0.05),but there was significant differences in the distance from tumor to anus(χ^(2)=5.011,P=0.025).The proportion of the distance from tumor to anus≤5 cm of submucosal origin lesions was significantly higher than that of deep mucosal origin[43.75%(14/32)VS 17.65%(3/17)].Endoscopic submucosal dissection[67.5%(27/40)]and transanal endoscopic microsurgery[25.0%(10/40)]were the major treatment method,but there were no significant differences in endoscopic ultrasonography manifestations and pathological grading of R-NENs between these two surgical procedures.Conclusion There is no significant difference in endoscopic ultrasonography manifestations and pathological grade of R-NENs between deep mucosal origin and submucosal origin,suggesting that the prognosis is

关 键 词：神经内分泌瘤 腔内超声检查 直肠 

分 类 号：R735.37[医药卫生—肿瘤]