超声内镜黏膜下剥离术在下消化管神经内分泌肿瘤的应用价值

The value of endoscopic ultrasonography and endoscopic submucosal dissection on neuroendocrine tumors of lower digestive tract

目的:研究超声内镜检查与内镜黏膜下剥离术(ESD)在下消化管神经内分泌肿瘤的应用价值。方法:回顾性分析我院近4年内收治的行ESD治疗的42例下消化管神经内分泌肿瘤患者的临床资料,并对其超声内镜下形态进行总结,记录患者的完整切除率、并发症发生率、病理特征和随访结果。结果:42例患者病灶部位共56个,均得到整块切除,切除病灶直径(7.3±2.5)mm,手术时间(35±11)min。术中发生直肠穿孔患者8例,使用钛夹夹闭成功,无一例患者中转外科手术,术后并未发现穿孔与迟发性出血。术后病理学检查结果提示,56个病灶完整切除率为92.8%(52个),余下4个病灶基底缘检出阳性。42例患者随访(21±7)个月,随访人数40例,失访2例,随访率95.2%。随访期间仅1例患者因直肠部病灶出现局部复发,行二次ESD完整切除,并未见淋巴结转移和远处转移。结论:超声内镜检查能清晰观察到下消化管神经内分泌肿瘤的来源层次,同时对内镜治疗的深度与范围进行指导,ESD是治疗下层下消化管神经内分泌肿瘤安全、有效的一种微创方式。

Objective： To study the value of endoscopic ultrasonography and endoscopic submucosal dissection（ ESD） on neuroendocrine tumors of lower digestive tract. Methods： A retrospective analysis was performed,42 patients with neuroendocrine tumors who received endoscopic ultrasonography were enrolled in this study in recent 4 years. The rate of complete resection and complication,pathological characteristics,effects were recored. Results：A total of 42 lesions were obtained in all of the patients in the study group. All of the patients were treated with enbloc resection. The diameter of the lesion was resected（ 7. 3 ± 2. 5） mm,and the operation time was（ 35 ± 11）min. There were 8 cases of rectal perforation in the operation,which were successfully operated with titanium clips.There was no surgical operation in all the patients. No perforation and delayed bleeding were found after operation.The results of pathological examination showed that the complete resection rate of 56 lesions was 92. 8%（ 52/56）,and the remaining 4 lesions were positive. 42 patients were followed up（ 21 ± 7） months,followed up by a total of 40 cases,lost to follow-up in 2 cases,the follow-up rate was 95. 2%. During the follow-up period,only 1 patient with local recurrence of rectal lesions underwent complete resection of ESD for two times,and no lymph node metastasis or distant metastasis was found. Conclusion： The source level of tube lower digestive neuroendocrine tumor can be observed clearly through encoscopic ultrasonograpyh,meanwhile,it can be used as a guideline for the treatment in depth and range of tumor. Endoscopic submucosal dissection can be a safety and effective treatment for the lower digestive neuroendocrine tumor.