胃肠道神经内分泌瘤内镜下治疗后切缘残留的临床及预后分析

Clinical and prognostic analysis on residual tumor at the resection margin after endoscopic treatment of gastrointestinal neuroendocrine tumors

目的探讨胃肠道神经内分泌瘤内镜下治疗后切缘残留的预后。方法回顾性分析129例胃肠道神经内分泌瘤内镜下治疗后切缘残留18例患者的临床资料及预后。结果129例胃肠道神经内分泌瘤内镜下治疗后切缘残留的阳性率为14.0%。切缘残留与肿瘤生长部位无关,与内镜下治疗方法及肿瘤浸润深度相关。成功随访16例患者中,1例死于其他疾病,2例转外科手术,2例补充内镜黏膜下剥离术(endoscopic submucosal dissection,ESD),其余11例均无复发及转移。结论采用ESD处理胃肠道神经内分泌瘤可减少切缘残留,优于内镜下黏膜切除术(endoscopic mucosal resection,EMR)及内镜下圈套切除。切缘残留的患者复发及转移的发生率不高,严密随访及观察或许可避免外科手术。

Objective To investigate the prognosis on residual tumor at the resection margin after endoscopic treatment of gastrointestinal neuroendocrine tumors.Methods The clinical data and prognosis for 129 patients according 18 patients with positive margin after endoscopic treatment were retrospectively analyzed.Results The rate of positive margin was 14.0%,which showed a significant difference among different endoscopic treatment methods and depth of tumor invasion and no significant difference among different location.Successful follow-up of 16 patients,1 patient died of other diseases,2 patients were converted to surgery,2 patients received additional endoscopic submucosal dissection(ESD)and other 11 patients had no recurrence and no metastasis.Conclusion ESD has been approved of endoscopic treatment of gastrointestinal neuroendocrine tumors moreover it enables us to secure a higher negative resection margin rate than endoscopic mucosal resection(EMR)and endoscopic polypectomy.The incidence of recurrence and metastasis for gastrointestinal neuroendocrine tumors patients in positive margin is not high.Extended surgical resection may be avoided with close follow-up and observation.