小于1.0 cm的直肠类癌内镜治疗方法探讨

Endoscopic therapies for smaller than 1.0 cm rectal neuroendocrine tumors

目的探讨不同内镜治疗方法治疗较小(病变大小≤1.0cm)直肠类癌的优缺点。方法回顾性分析2010年1月-2017年12月该院经肠镜检查且病理明确诊断为直肠类癌(病变大小≤1.0 cm)的患者49例,对患者的内镜临床资料进行回顾性分析,根据治疗方法不同分3组,内镜下黏膜切除术(EMR)组、内镜下套扎切除术(EMR-L)组和内镜黏膜下剥离术(ESD)组,以年龄、性别、病变大小、手术时间、并发症(出血、穿孔、感染)和完整切除率等指标为变量进行统计学分析,探讨3种治疗方法的优缺点。结果该研究共纳入49例小于1.0 cm直肠类癌,其中EMR组22例(44.90%),EMR-L组20例(40.82%),ESD组7例(14.28%),3种治疗方法年龄、性别和病变大小比较,差异均无统计学意义(P>0.05)。ESD术操作时间较EMR和EMR-L术操作时间长(均值1916.14、96.36和120.25 s,P <0.05),EMR术完整切除率较EMR-L和ESD术完整切除率低(72.73%、95.00%和100.00%,P <0.05),EMR-L组1例发生术中穿孔,经内镜下治疗后好转出院,EMR组2例发生术后出血,经内镜下止血治疗好转出院。入组病例均未发生复发、转移。结论 EMR-L治疗小于1.0 cm直肠类癌操作相对于ESD术简单,完整切除率较EMR术高,创伤小、术后处理简单、并发症少。

Objective To explore advantages and disadvantages of endoscopic resection for small rectal neuroendocrine tumors (smaller than 1.0 cm). In this study, we compared operative time, complete resection rate and complications of traditional EMR, modified EMR-L and ESD by retrospective analysis. Methods From January 2010 to December 2017, 49 patients with rectal neuroendocrine tumors diagnosed by colonoscopy and pathology were analyzed retrospectively. According to different treatment methods, three groups were analyzed, including age, gender, size of tumor, operation time, complications (bleeding, perforation and infection), complete resection rate. Results 49 patients were treated by EMR (n = 22) EMR-L (n = 20) ESD (n = 7). There was no significant difference in age, gender and size of tumor between three groups. A significant longer operation time was observed in ESD group (P < 0.05). A significant lower complete resection rate was observed in EMR group (P < 0.05). There was one perforation in group EMR-L and was discharged by endoscopic treatment. Two bleeding in group EMR and was discharged by endoscopic treatment. No recurrence or metastasis was found in all cases. Conclusions EMR-L is more simple for postoperative treatment, less traumatic, fewer complicatin compared with ESD, and the rate of complete resection is higher, compared with EMR.