内镜黏膜下剥离术治疗胃肠神经内分泌肿瘤效果及对血清VEGF、CgA的影响

Effects of endoscopic submucosal dissection on gastrointestinal neuroendocrine neoplasms,vascular endothelial growth factor and chromogranin A

目的研究内镜黏膜下剥离术(ESD)治疗胃肠神经内分泌肿瘤(GI-NENs)及对血清血管内皮生长因子(VEGF)、嗜铬粒蛋白A(CgA)的影响。方法选择2012年1月至2018年5月收治的GI-NENs患者106例,依据随机数字表法分为ESD组和对照组,每组53例。ESD组行ESD治疗,对照组行内镜下黏膜切除术(EMR)治疗。观察2组病变切除、术中穿孔情况,术中出血量、手术时间及住院时间等手术相关指标。术前、术后7 d 2组血清VEGF、CgA水平,血清CD^+3CD^+4、CD^+3CD^+8、CD^+4/CD^+8等免疫指标水平。2组术后1年复发及3年生存情况。结果ESD组治愈性切除率、整块切除率均高于对照组(P<0.05);2组基底病灶残余率、术中穿孔率无差异(P>0.05)。ESD组术中出血量少于对照组,手术时间、住院时间均长于对照组(P<0.05)。术后7 d,ESD组VEGFA、VEGFB、VEGFC及CgA水平均低于对照组(P<0.05),ESD组CD^+3CD^+4、CD^+3CD^+8高于对照组,CD^+4/CD^+8低于对照组(P<0.05)。ESD组术后1年复发率低于对照组,3年生存率高于对照组(P<0.05)。结论ESD治疗GI-NENs,可有效切除病灶,降低VEGF、CgA水平,恢复机体免疫,且术后生存率高,复发率低,值得推荐于临床。

Objective To explore the effect of endoscopic submucosal dissection(ESD)on gastrointestinal neuroendocrine neoplasms(GINENs),vascular endothelial growth factor(VEGF)and chromogranin A(CgA).Methods A total of 106 patients with GINENs,who were admitted and treated in our hospital from January 2012 to May 2018,were randomly divided into ESD group(n=53)and control group(n=53).The patients in ESD group were treated by ESD,however,the patients in control group were treated by endoscopic mucosal resection(EMR).The operation-related indexes including lesion resection,intraoperative perforation,intraoperative blood loss,operation time,hospitalization time,and the serum levels of VEGF and CgA,the levels of immune indexes including serum CD^+3CD^+4,CD^+3CD^+8,CD^+4/CD^+8 before operation and at 7d after operation were observed and compared between the two grousp.In addition,the 1-year recurrence rate after operation and 3-year survival rate after operation were also observed.Results The curative resection rate and the whole resection rate in ESD group were significantly higher than those in control group(P<0.05).There were no significant differences in residual rate of basal lesion and perforation rate during operation between the two groups(P>0.05).Moreover,the intraoperative blood loss in ESD group was less than that in control group,and the operation time and hospitalization time in ESD group were significantly longer than those in control group(P<0.05).At 7d after operation,the levels of VEGFA,VEGFB,VEGFC and CgA in ESD group were significantly lower than those in control group(P<0.05).The levels of CD^+3CD^+4 and CD^+3CD^+8 in ESD group were significantly higher than those in control group,while the levels of CD^+4/CD^+8 were significantly lower than those in control group(P<0.05).In addition,he 1-year recurrence rate after operation and 3-year survival rate after operation in ESD group were significantly higher than those in control group(P<0.05).Conclusion Treating GINENs by ESD can effectively remove lesions,reduce the levels of VEGF and CgA,recover body immunity function,with higher survival rate and lower recurrence rate,thus,it is worthy of promotion in clinical practice.