内镜黏膜下剥离术衍生技术内镜黏膜下挖除术在消化道神经内分泌肿瘤中的应用

Endoscopic submucosal excavation as the derivative technology of endoscopic submucosal dissection for the treatment of intestinal neuroendocrine tumor

目的探讨内镜黏膜下剥离术(ESD)衍生技术内镜黏膜下挖除术(ESE)治疗消化道神经内分泌肿瘤(NET)的安全性及其疗效。方法采用ESE方法对23例消化道NET进行治疗,术后标本送病理检查,记录不良反应发生情况及疗效,随访肿瘤复发及转移情况。结果肿瘤直径0.4~3.0 cm,中位大小1.0 cm,均一次性完整剥离切除,ESE手术时间(自黏膜下注射至完整剥离病变)20~75 min,中位手术时间30 min,1例出现迟发性出血,1例因肿瘤侵犯固有肌层主动穿孔全层切除。术后23例病理诊断为NET,其中G1级21例、G2级2例,3例胃NET中,1型2例,2型1例,基底和切缘均未见病变累及。中位随访28个月,无1例出现肿瘤复发和转移。结论 ESE治疗消化道NET具有较好的安全性和疗效,值得在临床上推广应用。

Objective To investigate the therapeutic effect and safety of ESE(endoscopic submucosal excavation)as the derivative technology of ESD(endoscopic submucosal dissection)for intestinal Neuroendocrine tumor.Methods A total of 23 lesions diagnosed as Neuroendocrine tumor were treated by ESE.Pathological diagnosis was performed.Reverse events were recorded.Patients were followed up for recurrence and metastasis.Results Lesions,0.4~3.0 cm(medium size 1.0 cm)in diameter,were all resected at one ESE procedure.The operation time was 20~75 min(medium 30 min).Postoperative bleeding occurred in one case.Initiative full thickness resection was made in one case due to the violation of muscularis propria layer.23 cases were histologically diagnosed as neuroendocrine tumor,with 21 as G1 and 2 as G2,none as G3.Within 3 gastric neuroendocrine tumors,2 were type 1 and 1 was type 2.All resected samples were free of residual tumor cell in the lateral and basal margins.Conclusion ESE is safe and efficacious for the treatment of intestinal neuroendocrine tumor.