低位直肠神经内分泌肿瘤手术方式选择的回顾性临床对照分析研究

A retrospective clinical comparative analysis study on the surgical method of low rectal neuroendocrine tumors

目的对比观察内镜黏膜下层剥离术(endoscopic submucosal dissection,ESD)与经肛门内镜微创手术(transanal endoscopic microsurgery,TEM)用于低位直肠神经内分泌肿瘤的治疗效果及安全性。方法选择低位直肠神经内分泌肿瘤(距肛缘≤7cm)患者89例(肿瘤分级G1和G2),根据病情需要分别给予ESD或TEM黏膜下手术切除治疗,其中35例患者采用ESD治疗,54例患者接受TEM治疗;观察2组术中出血量、手术时间、平均住院时间以及随访5年内2组肿瘤完全切除、穿孔和术后复发情况。结果 TEM组术中出血量少于ESD组,TEM组手术时间和平均住院时间少于ESD组,差异有统计学意义(P<0.05);2组肿瘤完全切除、穿孔和术后复发率差异无统计学意义(P>0.05)。结论 TEM治疗低位直肠神经内分泌肿瘤具有良好效果,术中出血量少,手术时间和平均住院时间短,值得临床推广。

Objective To observe and compare the efficacy and safety of the endoscopic submucosal dissection（ESD） and transanal endoscopic microsurgery（TEM） in the treatment of lower rectal neuroendocrine tumors.Methods Eighty-nine patients（grades G1 and G2） with low-grade rectal neuroendocrine tumors（≤7 cm from the anus） were included in this study. Thirty-five patients were treated with ESD and fifty-four patients were treated with TEM. The operative time, intraoperative blood loss, average hospital stay were compared, And complete resection rate, perforation, and postoperative recurrence rate were followed up for 5 years after operation.Results The intraoperative blood loss of the patients in the TEM group was less than that in ESD group（ P〈0.05）. The operative time and the hospital stay of the patients in the TEM group were shorter than those in ESD group（ P 〈 0.05）. There was no difference in complete resection rate, perforation, and postoperative recurrence rate between the two groups（ P 〉 0.05）.Conclusion Compared with TEM has the advantages of less intraoperative blood loss, shorter operative time, and shorter hospital stay,and is worthy of clinical promotion.