内镜超声检查指导下内镜黏膜下剥离术治疗直肠神经内分泌肿瘤患者的临床研究  

Clinical research of endoscopic ultrasonography-guided endoscopic submucosal dissection in the treatment of patients with rectal neuroendocrine tumor

作　　者：桂冠 王河 易健 GUI Guan;WANG He;YI Jian(Department of Gastroenterology,Yichun People’s Hospital,Yichun 336000,Jiangxi,China)

机构地区：[1]宜春市人民医院消化内科,江西宜春336000

出　　处：《癌症进展》2024年第8期877-880,共4页Oncology Progress

基　　金：江西省卫生健康委科技计划项目(20204739)。

摘　　要：目的探讨内镜超声检查(EUS)指导下内镜黏膜下剥离术(ESD)治疗直肠神经内分泌肿瘤(RNET)患者的临床疗效。方法选取60例RNET患者,均在EUS指导下行ESD治疗并随访1年,记录全部患者EUS检查结果、ESD治疗情况及随访情况。比较治疗前后RNET患者的生活质量[胃肠神经内分泌肿瘤患者生活质量量表(QLQ-GI.NET21)]、血清肿瘤标志物[癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、糖类抗原19-9(CA19-9)、嗜铬粒蛋白A(CGA)]水平。结果60例患者共67个病灶,EUS检查显示,4个病灶来源于黏膜层,5个病灶来源于黏膜肌层,58个病灶来源于黏膜下层;5个病灶距肛门﹥10 cm,28个病灶距肛门≤10 cm且﹥5 cm,34个病灶距肛门≤5 cm。60例患者均采取ESD治疗,平均手术时间为(30.86±9.86)min,平均病灶直径为(0.82±0.26)cm。62个病灶实现了完全切除,另外5个病灶基底切缘呈阳性(均在术中追加外科手术治疗),完全切除率为92.54%(62/67)。术后病理检查结果显示,63个病灶为G1级,4个病灶为G2级。术后5例患者发生出血,3例患者在内镜下经钛夹止血,2例患者予以药物保守治疗。治疗后,RNET患者QLQ-GI.NET21各维度评分及血清NSE、CEA、CGA、CA19-9水平均明显低于治疗前,差异均有统计学意义(P﹤0.01)。60例患者随访过程中均未发生复发和/或转移。结论EUS能够清楚地显示RNET病灶,并能有效指导ESD治疗,EUS指导下ESD治疗RNET具有一定的有效性和安全性。Objective To investigate the clinical efficacy of endoscopic ultrasonography(EUS)-guided endoscopic submucosal dissection(ESD)in the treatment of patients with rectal neuroendocrine tumor(RNET).Method Sixty RNET patients were selected,all patients underwent EUS-guided ESD treatment and followed up for 1 year.The EUS examination results,ESD treatment and follow-up of all patients were recorded.The quality of life[quality of life scale for gastrointestinal neuroendocrine tumors-21(QLQ-GI.NET21)]and serum tumor markers[carcinoembryonic antigen(CEA),neuronal specific enolase(NSE),carbohydrate cancer antigen 19-9(CA19-9)and chromogranin A(CGA)]levels of RNET patients before and after treatment were compared.Result A total of 67 lesions were detected in 60 patients.EUS showed that 4 lesions were from the mucosal layer,5 lesions from the mucosal myometria,and 58 lesions from the submucosal layer.Five lesions were>10 cm from the anus,28 lesions were≤10 cm and>5 cm from the anus,and 34 lesions were<5 cm from the anus.All 60 patients were treated with ESD,and the mean operation time was(30.86±9.86)min,the mean diameter of lesions was(0.82±0.26)cm.Complete resection was achieved in 62 lesions,and the basal margin of the other 5 lesions were positive(all of which were treated with additional surgery during the operation),with a complete resection rate of 92.54%(62/67).The results of postoperative pathological examination showed that 63 lesions were G1 grade and 4 lesions were G2 grade.Postoperative hemorrhage occurred in 5 patients,3 patients underwent endoscopic hemostasis with titanium clamp,and 2 patients received conservative treatment with drugs.After treatment,the dimensional scores of QLQ-GI.NET21 and serum NSE,CEA,CGA and CA19-9 levels of RNET patients were significantly lower than those before treatment,and the differences were statistically significant(P<0.01).No recurrence and/or metastasis occurred in 60 patients during follow-up.Conclusion EUS can clearly display RNET lesions,and can effectively guide ESD tr

关 键 词：内镜超声检查 内镜黏膜下剥离术 直肠神经内分泌肿瘤 病理检查 

分 类 号：R735.37[医药卫生—肿瘤]