内镜诊断与治疗19例消化道神经内分泌瘤分析

Endoscopic diagnosis and treatment of 19 cases of gastrointestinal neuroendocrine tumors

目的探讨消化道神经内分泌瘤（NET）的内镜诊断、治疗及预后。方法收集某院经组织病理学和免疫组化确诊的19例胃肠道NET病历资料进行分析。结果 19例中肿瘤单发17例,多发2例,内镜表现为息肉、糜烂、溃疡、隆起病变等。直径≤10 mm病变,内镜窄带成像（NBI）见病变表面毛细血管增粗或不规则,伴腺体缺失,超声内镜见病灶位于黏膜层;直径〉15mm,NBI见病变表面毛细血管明显减少,超声内镜见病变已累及黏膜下层。对病变直径≤15 mm,病变局限于黏膜层,黏膜下层完整的14例患者行内镜下切除治疗,术后随访4~48个月,未见复发和转移。结论消化道NET内镜特点缺少特异性;对病变局限于黏膜及黏膜下层且直径≤10 mm病灶,内镜下切除是有效、安全的。

Objective To investigate endoscopic diagnosis, treatment and prognosis of the gastrointestinal neuroendocrine tumors. Methods Medical records of 19 cases of gastrointestinal neuroendocrine tumors diagnosed by bistopathology and immunohistoehemistry were analyzed. Results Seventeen out of 19 cases were single lesion and 2 cases were multiple lesions. Gastrointestinal neuroendoerine tumors shown as polyp, erosions ,ulcers, apophysis lesions under endoscopy. Lesion diameter ~〈 10 mm Narrow band imaging （NBI） endoscopicexamination showed thickening of the capillary surface or pole irregular, accompanied by the absence of glands, EUS showed lesions in the mucous layer. Diameter〉15 mm NBI examination showed significantly reduced lesion surface capillaries,sparsely-like structure,EUS showed lesions involving the submucosa. The 14 patients with lesion diameter ~〈 15 mm and confined to the mucosa by EUS were underwent a complete endoscopic resection. Follow-up period was 4-48 months. All patients had no recurrence and metastasis. Conclusions The clinical symptoms and endoscopic characteristics of gastrointestinal neuroendocrine tumors lack of specificity. For lesions confined to the mucosa and submucos and a diameter ≤10 mm lesions, endoscopic resection is effective and safe.