内镜诊治直肠神经内分泌瘤33例临床病理分析

The Clinicopathological Analysis of 33 Cases with Rectal Neuroendocrine Tumor by the Diagnosis and Treatment with Endoscopic Ultrasonography

目的评价超声内镜(EUS)对直肠神经内分泌瘤(NET)诊断的准确性及内镜黏膜下剥离术(ESD)的近期疗效;分析直肠NET的病理特征。方法回顾性收集行ESD术的直肠NET患者,分析病理结果并比较EUS结果与病理的一致性。术后按期复查随访评估近期疗效。结果共纳入33例患者,EUS诊断病变深度及直径的准确率分别为85.71%及82.14%。所有病例均整块切除,完全切除率为90.91%,术后随访无局部复发及远处转移者。病理结果示,G1级24例,G2级9例,无G3级。统计分析示,病理分级与病变直径相关(P=0.028),而与浸润深度无相关性(P=0.278)。免疫组化显示,G1、G2级各指标阳性率差异无统计学意义(P>0.05)。结论EUS对直肠NET诊断准确率较高;ESD对直肠直径<15 mm的NET根治性切除率高,安全有效。

Objective To evaluate the diagnostic accuracy of endoscopic ultrasonography(EUS)and the short-term efficacy of endoscopic submucosal dissection(ESD)for rectal neuroendocrine tumor(NET)and analyze the pathological features of rectal NET.Methods The patients diagnosed with rectal NET and treated with ESD were retrospectively collected to analyze their pathological results and compare their EUS results with their pathological results to examine the consistency.The patients were followed up and reviewed regularly to evaluate the short-term efficacy.Results A total of 33 patients were included in this study.The diagnostic accuracy of EUS in diagnosing the lesion depth and diameter was 85.71%and 82.14%respectively.All cases were treated with enbloc resection with the R0 resection rate of 90.91%and there were no local recurrence or distant metastasis found during the follow-up period.The pathological results showed that there were 24 cases of Grade G1,9 cases of Grade G2 and no case of Grade G3.The results of the statistical analysis indicated that the pathological grading was correlated with the lesion diameter(P=0.028)and not correlated with the infiltration depth(P=0.278).The immunohistochemical results showed that there was no significant difference in the positive rates of the various indexes between the patients of Grade G1 and Grade G2(P>0.05).Conclusion EUS is highly accurate in the diagnosis of rectal NET.ESD is safe and effective with a high rate of radical resection in the treatment of rectal NET with the diameter less than 15mm.