内镜下不同微创治疗术对直肠神经内分泌肿瘤的疗效及复发影响分析  

Analysis of the effi cacy and postoperative recurrence rate of diff erent endoscopic minimally invasive treatments for rectal neuroendocrine neoplasms

作　　者：贺友豪 管鑫[2] 姜相君[2] He Youhao;Guan Xin;Jiang Xiangjun(Graduate School of Dalian Medical University,Liaoning Dalian 1160442,China;Second Gastroenterology Department of Qingdao Municipal Hospital,Shandong Qingdao 266000,China)

机构地区：[1]大连医科大学研究生院,辽宁大连116044 [2]青岛市市立医院消化内科,山东青岛266000

出　　处：《临床普外科电子杂志》2024年第2期18-24,29,共8页Journal of General Surgery for Clinicians(Electronic Version)

摘　　要：目的探讨在超声内镜精准定位瘤体体积及层次下比较内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)、内镜黏膜切除术(endoscopic mucosal resection,EMR)、内镜黏膜下挖除术(endoscopic submucosal excavation,ESE)治疗直肠神经内分泌瘤的疗效及复发率。方法回顾性分析2018年10月至2022年7月就诊于青岛市市立医院并行内镜下微创治疗,且病理诊断为直肠神经内分泌肿瘤患者的临床资料,分析直肠神经内分泌肿瘤内镜学特征、术前影像学检查、超声内镜诊断及EMR、ESD和ESE术式的手术资料、病理资料、术后随访情况。结果共纳入95例患者临床资料,其中行ESD 52例(ESD组)、行EMR 30例(EMR组)、ESE 13例(ESE组)。ESD组切除病变平均最大直径显著大于EMR组,ESD组相对于EMR组具有更大的瘤体切除面积,差异均有显著性(P<0.05)。ESD组和ESE组的手术时间明显长于EMR组,差异具有显著性(P<0.05)。3种方法在术中外科补救情况、术后切缘累及率、术后并发症的出现情况、术后出院时间、术后复发率上并无显著差异(P>0.05)。超声内镜检查示病变大多呈低回声,边界清,管壁完整,病变主要来源于黏膜下层及黏膜肌层。结论术前根据超声内镜定位瘤体体积和层次后选择最合适的内镜微创手术方式,利用EMR、ESD、ESE各术式优势,可提高手术安全性。Objective Exploring the comparison of the effi cacy and recurrence rate of endoscopic submucosal dissection(ESD),endoscopic mucosal resection(EMR),and endoscopic submucosal resection(ESE)in the treatment of rectal neuroendocrine tumors under the precise localization of tumor volume and level using endoscopic ultrasound.Method Retrospective analysis of clinical data of patients who received endoscopic minimally invasive treatment at Qingdao Municipal Hospital from October 2018 to July 2022 and were pathologically diagnosed with rectal neuroendocrine tumors.Analysis of preoperative imaging features,endoscopic ultrasound diagnosis,surgical data,pathological data,and postoperative follow-up of EMR,ESD,and ESE surgical methods for rectal neuroendocrine tumors.Result A total of 95 patients were included in the clinical data,including 52 who underwent ESD surgery,30 who underwent EMR surgery,and 13 who underwent ESE surgery.The average maximum diameter of lesions removed in the ESD group was signifi cantly larger than that in the EMR group,and the ESD group had a larger tumor resection area compared to the EMR group,with signifi cant diff erences(P<0.05).The surgical time of ESD group and ESE group was signifi cantly longer than that of EMR group,and the diff erence was signifi cant(P<0.05).There was no signifi cant diff erence among the three methods in terms of intraoperative surgical rescue,postoperative margin involvement rate,occurrence of postoperative complications,postoperative discharge time,and postoperative recurrence rate(P>0.05).Endoscopic ultrasound examination shows that most of the lesions are hypoechoic,with clear boundaries and intact tube walls.The lesions mainly originate from the submucosal layer and mucosal muscle layer.Conclusion Before surgery,the most suitable endoscopic minimally invasive surgery method is selected based on the localization of tumor volume and level by endoscopic ultrasound.By utilizing the advantages of EMR,ESD,and ESE,the surgical safety can be improved.

关 键 词：神经分泌肿瘤 直肠 超声内镜 内镜下黏膜剥离术 内镜下黏膜挖除术 

分 类 号：R735.37[医药卫生—肿瘤]