结扎装置辅助内镜黏膜下切除术对比剥离术治疗小直肠神经内分泌肿瘤的疗效观察

Effect of Endoscopic Submucosal Resection with a Ligation Device and EndoscopicSubmucosal Dissection for the Small Rectal Neuroendocrine Tumor

目的评价结扎装置辅助内镜黏膜下切除术(endoscopic submucosal resection with ligating device,ESMR-L)与内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗直径<1.0 cm的直肠神经内分泌肿瘤(rectal neuroendocrine tumors,r-NETS)的安全性与疗效差异。方法回顾性分析内镜下治疗的43名r-NETS患者的临床资料,其中ESMR-L组23例,ESD组20例,并进行内镜随访,研究不同手术方式患者在整块切除率、组织学完整切除率、手术时间、并发症、住院总费用、随访结果等方面的差异。结果2种手术方式的整块切除率均为100%。ESD组中组织学完整切除率略高于ESMR-L组(100%vs 95.6%),但差异性比较无统计学意义(P>0.05)。ESD组的平均手术时间显著长于ESMR-L组(P<0.05),ESD组平均住院时间也明显长于ESMR-L组(P<0.05),ESD组平均住院费用明显高于ESMR-L组(P<0.05)。ESD组中有1例术中肌层损伤,ESMR-L组中有1例迟发出血,内镜下处理后2组均无外科干预。随访期间2组患者均无局部复发及远处转移。结论ESMR-L和ESD均可有效治疗直径<1.0 cm r-NETS,但ESMR-L比ESD手术方式更简单,耗时更短,花费更少。

Objective To compare the difference of efficacy and safety between endoscopic submucosal resection with a ligation device(ESMR-L)and endoscopic submucosal dissection(ESD)for the rectal neuroendocrine tumors of diameter(rNETs)<1.0 cm.Methods 43 patients with rNETs(d<1.0 cm)treated by colonoscopy were analyzed retrospectively.According to different treatment methods,43 patients were divided into ESMR-L group(n=23)and ESD group(n=20).The treatment results of different groups were compared,including baseline characteristics,the rate of en-bloc resection,pathological complete resection,operation time,complications,total hospitalization cost and time,and follow-up results.Results The rate of en-bloc resection was 100%in both groups.The complete endoscopic resection of the ESD group was slightly higher than that of the ESMR-Lgroup(100%vs 95.6%),but the difference was not statistically significant(P>0.05).The average operation time of the ESD group was significantly longer than that of the ESMR-L group(P<0.05).The average hospitalization period of the ESD group was also significantly longer than that of theESMR-L group(P<0.05),and the hospitalization cost of the ESD group was significantly higher than that of the ESMR-L group(P<0.05).There was 1 case of intrinsic muscular layer injury in the ESD group,and 1 case of postoperative bleeding in the ESMR-L group.There was no surgical intervention in both groups after endoscopic treatment.There were no local recurrence and distant metastasis in both groups during the follow-up period.Conclusion Both ESMR-L and ESD can effectively treat small rNETs,but ESMR-L is simpler,less time-consuming and less costly than ESD.