EMR-C及ESD在直肠神经内分泌肿瘤治疗中的应用效果比较

Comparison of Endoscopic Mucosal Resection Using a Cap and Endoscopic Submucosal Dissection for the Treatment of Small Rectal Carcinoid Tumors

目的比较透明帽辅助内镜下黏膜切除术(EMR-C)及内镜黏膜下剥离术(ESD)治疗直肠神经内分泌肿瘤的效果。方法回顾性分析2012年10月至2017年10月在本院内镜中心就诊并行内镜下切除治疗的直径<10 mm的52例直肠神经内分泌肿瘤患者病历资料,根据手术的方式分为EMR-C组(n=29)和ESD组(n=23),比较两组手术时间、完整切除率、术后并发症发生率以及复发情况。结果两组患者年龄、肿物大小及距肛缘距离、完整切除率差异均无统计学意义(均P>0.05),EMR-C组手术时间较ESD短(P<0.05),ESD组有2例出现术后迟发性出血,两组均没有出现穿孔病例。结论直肠神经内分泌肿瘤患者应用EMR-C与ESD行内镜下治疗,两者的完整切除率相当,但前者手术时间更短,术后并发症更少,可以作为内镜下治疗直肠神经内分泌肿瘤的优先选择。

Objective To compare the effect of endoscopic mucosal resection using a transparent cap（EMR-C） and endoscopic submucosal dissection（ESD） for endoscopic resection of small rectal carcinoid tumors. Methods We retrospectively analyzed the data from 52 patients with small rectal carcinoid tumors（10 mm） treated in our hospital from October 2012 to October 2017. 29 patients were treated by EMR-C and 23 by ESD. Operation duration, complete resection rate, incidence of postoperative complications and recurrence rate were compared between the two groups. Results There was no significant difference between the two groups in age, diameter of tumors, distance of the tumor from the anal verge, complete resection rate（P〈0.05）. The duration of operation was significantly shorter in EMR-C group than in ESD group（P〈0.05）. Two patients in the ESD group had delayed bleeding after the operation. No patient had perforation. Conclusion Compared with ESD, EMR-C has a comparable complete resection rate, but EMR-C has shorter operation duration, lower risk of postoperative complications. It could be considered a first-line choice for treating small rectal carcinoid tumors.