胃肠道神经内分泌肿瘤的内镜下诊断与治疗

Endoscopic diagnosis and treatment of gastrointestinal neuroendocrine neoplasms

目的探讨胃肠道神经内分泌肿瘤(neuroendocrine neoplasms,NENs)的内镜下诊断及治疗方法。方法对50例经内镜及病理学证实的NENs进行回顾性分析,分析其内镜下表现及治疗方法。结果胃肠道NENs的发病部位以直肠(38/50)和胃(8/50)最为常见,直肠NENs在内镜下有一定特征性表现,但胃、食管、十二指肠NENs在内镜下表现形式多样,无特定典型表现。部分患者经内镜下黏膜切除术(endoscopic mucosal resection,EMR)、内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)或胃镜与腹腔镜双镜联合治疗,其中1例胃NENs表现为胃体6枚息肉样隆起,活检病理示炎性改变,遂行EMR切除,其病理回报NET 2级(G2),肿瘤紧靠基底及侧切缘,遂行二次ESD分别切除胃内NENs病灶残根。所有患者均完整切除瘤体,无术中及术后迟发性出血发生。随访内镜下治疗的患者目前均无复发及转移。结论胃肠道NENs主要通过内镜及病理学检查确诊,对于部分位于黏膜深层或黏膜下层、直径≤1 cm的瘤体可通过ESD在内镜下切除。

Objective To investigate the endoscopic diagnosis and treatment of gastrointestinal neuroendocrine neoplasms （NENs）.Methods Endoscopic manifestation and treatment in 50 patients identified gastrointestinal NENs by endoscopy and pathology were analyzed retrospectively.Results Rectum （38/50） and stomach （8/50）were the most common of gastrointestinal NENs.There were certain features under endoscopic in rectal NENs but diverse forms and no specific typical performance under endoscopy in esophageal,gastric and duodenal NENs.Partly patients underwent endoscopic submucosal dissection （ESD）,endoscopic mucosal resection （EMR） or laparoscopy combined with endoscopy resection by endoscopic therapy.A gastric NENs case manifested 6 polypoid protuberant in gastric body,and its biopsy showed inflammatory.The EMR was operated and the pathological was NET G2,the tumor was close to the basal and lateral margin.Then ESD was operated twice to dissect the NENs gastric lesion residual root.All patients underwent complete resection of the tumors.No bleeding happened during and after the operation.All patients after therapy were followed up for without recurrence and metastasis.Conclusion Gastrointestinal NENs can be diagnosed by endoscopy and pathological examination.Partial tumors that located in mucosa or submucosa,and diameter less than 1 cm could be resected through endoscopy.