胃肠道神经内分泌肿瘤的内镜下表现及治疗

Endoscopic findings and treatment of gastrointestinal neuroendocrine neoplasms

目的探讨胃肠道神经内分泌肿瘤（neuroendocrine neoplasms，NEN）的内镜下表现及治疗方法。方法对2011年5月至2014年12月在北京军区总医院消化内镜中心经内镜和病理确诊的72例胃肠道NEN患者进行回顾性分析，分析其内镜下特点及治疗方法。结果72例胃肠道NEN中以直肠最多见（48例，66．7％），其次为胃（16例，22．2％），十二指肠、食管和回盲瓣也可见。直肠NEN在内镜下有一定特征性表现，大多表现为黏膜下肿物；而胃、食管、小肠NEN在内镜下表现形式多样，无特定典型表现形式，容易误诊。部分诊断为神经内分泌瘤1级或神经内分泌瘤2级的患者经内镜黏膜下剥离术或内镜与腹腔镜双镜联合治疗，病理诊断为神经内分泌瘤2级或神经内分泌癌的患者，行外科手术切除、静脉化疗或姑息治疗。行内镜下治疗的50例患者均成功完成手术，1例十二指肠球部神经内分泌瘤1级患者在ESD术中发生穿孔，无出血发生。随访平均（15．6±13．2）个月，内镜下治疗的患者目前均无局部复发及远处转移。结论胃肠道NEN在内镜下表现形式多样，对于部分位于黏膜深层或黏膜下层、直径不超过1em的瘤体可采用内镜手术切除。

Objective To investigate the endoscopic findings and treatment of gastrointestinal neuroendocrine neoplasms. Methods Endoscopic manifestation and treatment were analyzed retrospectively in 72 patients who were diagnosed as having gastrointestinal neuroendocrine neoplasms by endoscopy and pathol- ogy from May 2011 to December 2014. Results In 72 patients of gastrointestinal NEN, rectum was most commonly involved （48 patients, 66. 7% ）, followed by the stomach （ 16 patients, 22. 2% ）, duodenum, esophagus and the ileoceeal valve. There were certain features in rectal neuroendocrine neoplasms under endoscopy,mostly manifested by submueosal tumors. But gastric, esophageal, and small intestine NEN manifestations showed various forms, without specific typical features, and easy to be misdiagnosed. Some patients diagnosed as having NEN G1 or G2 underwent EMR, ESD or laparoscopy combined with endoscopy resection. Patients diagnosed as having NEN G2 or neuroendocrine carcinoma by pathology received surgical resection, chemotherapy or palliative treatment. All 50 patients underwent endoscopic treatment successfully. Perforation occurred in one duodenal bulbar G1 patient during ESD. No bleeding occurred during and after the operation. All patients after treatment were followed up for 15.6 ± 13.2 months on average with no recurrence or metastasis. Conclusion Manifestations of gastrointestinal neuroendocrine neoplasms vary under endoscopy. Some tumors that locate in mucosa or submucosa with diameter less than 1 em can be resec- ted through EMR or ESD.