直肠神经内分泌肿瘤的内镜超声特征及其应用价值  

Endoscopic Ultrasonographic Characteristics of Rectal Neuroendocrine Neoplasms and its Application Value

作　　者：胡梦园 李明[1] 谭诗云[1] HU Mengyuan;LI Ming;TAN Shiyun(Department of Gastroenterology,Renmin Hospital of Wuhan University,Wuhan,430060)

机构地区：[1]武汉大学人民医院消化内科,430060

出　　处：《胃肠病学》2024年第8期449-453,共5页Chinese Journal of Gastroenterology

基　　金：国家自然科学基金(82004114)。

摘　　要：背景:随着内镜技术的发展,直肠神经内分泌肿瘤(R⁃NEN)的发病率逐年上升。R⁃NEN病症不典型且存在转移风险,及早准确定位肿瘤原发部位对其诊治至关重要。目的:归纳总结R⁃NEN的内镜超声(EUS)特征,比较EUS与病理诊断的一致性并分析差异形成原因。方法:回顾性收集2016年1月—2023年12月在武汉大学人民医院经病理确诊的R⁃NEN患者,复习其临床、内镜、影像学和病理学资料,比较EUS与病理检查判断病灶浸润深度的一致性并分析其影响因素。结果:共127例R⁃NEN患者纳入研究,男性占54.3%,平均年龄(51.0±12.3)岁。内镜下病灶多为位于直肠黏膜⁃黏膜下层的光滑球形或半球形隆起,平均直径(0.77±0.62)cm,距肛缘(6.58±2.51)cm。EUS与病理检查对累及黏膜⁃黏膜下层病灶浸润深度的诊断符合率为98.3%(116/118),对累及固有肌层及以上层次病灶浸润深度的诊断符合率则仅为55.6%(5/9),差异有统计学意义(Kappa=0.600,P<0.001)。多因素Logistic回归分析显示,对于直径10~20 mm的病灶,EUS与病理诊断一致性较高(OR=5.07,95%CI:1.34~19.12,P=0.017),而病灶位于直肠上段(OR=0.05,95%CI:0.01~0.75,P=0.031)、累及固有肌层及以上层次(OR=0.05,95%CI:0.01~0.59,P=0.017)可对EUS诊断产生负性影响。结论:EUS对R⁃NEN病灶的定位准确性较高,可作为可疑R⁃NEN初步诊断的关键方法。对位于直肠上段、浸润层次较深的病灶,应进行更规范的操作和更细致的分析。Background:With the development of endoscopic techniques,the incidence of rectal neuroendocrine neoplasms(R⁃NEN)is increasing year by year,and the atypical symptoms and risk of metastasis make early and accurate localization of the primary site essential for its diagnosis and treatment.Aims:To explore the endoscopic ultrasonographic characteristics of R⁃NEN,compare the consistency of the diagnosis between endoscopic ultrasonography(EUS)and pathology,and analyze the reasons for the differences.Methods:Patients with pathologically confirmed R⁃NEN from January 2016 to December 2023 at the Renmin Hospital of Wuhan University were recruited retrospectively in this study.Data on clinical,endoscopic,radiological and pathological manifestations were analyzed.Based on postoperative pathology,the diagnostic performance of EUS on the infiltration depth of the lesions was assessed,and the factors affecting the diagnostic accuracy of EUS were identified.Results:A total of 127 patients with R⁃NEN were included in this study,54.3%were male patients,with an average age of(51.0±12.3)years old.Most of the lesions seen endoscopically were smooth spherical or hemispherical elevations located at the mucosal⁃submucosal layer of the rectum,with an average diameter of(0.77±0.62)cm,and a distance of(6.58±2.51)cm from the anal verge.For lesions involving the mucosa⁃submucosa,the agreement rate of EUS with pathology was 98.3%(116/118),while for lesions involving the muscularis propria and above,the agreement rate was only 55.6%(5/9).The difference was statistically significant(Kappa=0.600,P<0.001).Multivariate Logistic regression analysis revealed that the diagnostic accuracy of EUS for lesions of 10⁃20 mm in diameter was acceptable(OR=5.07,95%CI:1.34⁃19.12,P=0.017),whereas lesions located at the upper rectum(OR=0.05,95%CI:0.01⁃0.75,P=0.031)and lesions involving the muscularis propria and above(OR=0.05,95%CI:0.01⁃0.59,P=0.017)could negatively affect the diagnostic accuracy of EUS.Conclusions:EUS has high localization

关 键 词：直肠神经内分泌肿瘤 内镜超声检查 诊断 

分 类 号：R73[医药卫生—肿瘤]