内镜超声在胃肠神经内分泌瘤诊治中的应用价值

Endoscopic ultrasonograghy in diagnosis and treatment of gastrointestinal neuroendocrine neoplasms

【摘要】目的探讨EUS在胃肠神经内分泌瘤（GI—NEN）诊治中的应用价值。方法回顾性总结44例行内镜检查并经组织病理及免疫组化确诊的GI—NEN患者的临床资料、EUS下特点及EUS指导下的内镜治疗情况和术后随访结果。结果44例共发现47处病灶（其中有2例为多发），其中4l处病理证实为神经内分泌瘤，6处病理证实为神经内分泌癌。EUS诊断41处神经内分泌瘤中18处起源于黏膜层、23处起源于黏膜下层，与病理结果符合率为100．O％，均为低回声团块，内部回声均匀，边界较清楚。41处神经内分泌瘤均行EUS指导下的内镜切除术，其中17处行EMR或ESD切除、24处行高频电切除，术后患者均恢复良好，分别于术后3—6个月、12个月复查胃肠镜和（或）EUS，显示创面愈合良好，病变切除处胃肠壁各层次清晰，原病灶边缘取组织活检均证实无残留及复发。结论EUS可准确判断GI—NEN病灶的起源、大小、边界、回声等，为最佳治疗方式的选择提供重要信息，在GI—NEN的诊治中有较高的应用价值。

Objective To investigate the value of endoscopic ultrasonograghy （EUS） in diagnosis and treatment of gastrointestinal neuroendocrine neoplasm （GI-NEN）. Methods We retrospectively sum- marized the clinical data of 44 patients with GI-NEN which were confirmed by pathology and immunohisto- chemistry, and analyzed the EUS features and the follow-up data of patients who received EUS exam and EUS-assisted endoscopic resection. Results A total of 47 neoplasms were detected in 44 patients, in which 41 were confirmed as neuroendocrine tumors （NET） and 6 were neuroendocrine carcinoma （NEC）. Under EUS, all 41 NET appeared as hypoechoic lesions with regular edge and homogeneous echographic pattern, and 18 were originated from mucosal layer and 23 from submucosal layer, which was all confirmed by patho- logical evaluation. All 41 NET lesions received EUS-assisted endoscopic resection, in which 17 were treated by ESD/EMR and 24 by high frequency electrotomy. Follow-up endoscopy was performed at 3-6 and 12 month after operation, which showed no residual or recurrence. Conclusion EUS may accurately deter- mine the invasion depth of GI-NEN lesions, and provide important information for adapting appropriate treat- ment strategies, which has highly clinical practice value in the diagnosis and treatment of GI-NEN.