内镜下黏膜剥离与黏膜切除治疗早期消化道神经内分泌肿瘤的有效性及安全性分析

Effectiveness and safety of endoscopic mucosal dissection and mucosal resection in the treatment of early gastrointestinal neuroendocrine tumors

目的分析内镜下黏膜剥离(ESD)与黏膜切除(EMR)治疗早期消化道神经内分泌肿瘤(NET)的有效性及安全性。方法选取2014年1月-2018年6月东南大学附属中大医院江北院区消化内科收治早期NET接受内镜手术治疗患者98例作为研究对象,根据手术治疗方案不同分为EMR组和ESD组,各49例。患者分别接受EMR或ESD治疗后,组织病理学评价肿瘤整块切除率、完全切除率,记录并比较2组患者手术指标(包括手术时间、住院时间、住院费用)及术后并发症。结果 2组患者平均手术时间、住院时间、住院费用比较差异均有统计学意义(t=7.584、4.749、17.204,P均=0.000);EMR组整块切除率、完全切除率、切除病灶平均直径均优于ESD组(χ^2/P=6.282/0.012,4.141/0.042、t/P=4.132/0.000);ESD组患者并发症发生率较EMR组高(χ^2=6.682,P=0.010);术后随访12个月EMR组4例患者复发再次行ESD治疗。结论 ESD有助于提高肿物彻底清除效果,临床治疗效果优于EMR,但手术安全性较差,手术时间长、并发症多,需进一步改善。

Objective To analyze the efficacy and safety of endoscopic mucosal dissection(ESD)and mucosal resection(EMR)in the treatment of early gastrointestinal neuroendocrine tumors(NET).Methods From January 2014 to June 2018,98 patients with early NET who underwent endoscopic surgery in Jiangbei Hospital of Zhongda Hospital Affiliated to Southeast University were selected as the study subjects.According to the different surgical treatment schemes,they were divided into EMR group and ESD group,49 cases in each group.After treatment with EMR or ESD,the resection rate and complete resection rate were evaluated by histopathology.The operative indexes(including operation time,hospitalization time,hospitalization cost)and complications were recorded and compared between the two groups.Results There were significant differences in the mean operative time,hospitalization time,and hospitalization expenses between the two groups(t =7.584,t=4.149,t=17.204,P=0.000);EMR group total resection rate,complete resection rate,resection The average diameter of the lesions was better than that of the ESD group(χ~2/P =6.282/0.012,χ~2/P =4.141/0.042,t/P =4.132/0.000);the incidence of complications in the ESD group was higher than that in the EMR group(χ~2 =6.682,P=0.010);4 patients in the EMR group had recurrence of ESD after 12 months of follow-up.Conclusion ESD can help to improve the effect of thorough removal of tumors.The clinical effect is better than EMR.However,the safety of operation is poor,the operation time is long and the complications are many,which need to be further improved.