胃肠道神经内分泌肿瘤手术方式选择的对照研究

Retrospective comparative analysis of surgical procedures for gastrointestinal neuroendocrine neoplasms

目的:探讨胃肠道神经内分泌肿瘤(GI-NENs)的内镜表现、诊治方法及预后相关因素。方法:回顾性分析行内镜切除或外科手术诊治的119例GI-NENs患者的临床资料,比较2种治疗方式的疗效和预后。结果:119例GI-NENs患者,病灶分布以直肠最多见(83例,69.75%),其次为胃(13例,10.92%)和十二指肠(12例,10.08%)。病灶直径≤1 cm者54例,1~2 cm者49例,≥2 cm者16例。119例中G1级65例,G2级54例。80例患者采用内镜下治疗,包括73例G1级和7例G2级患者;39例患者采用外科手术治疗,包括28例G1级和11例G2级患者。2组完全切除率差异无统计学意义(93.75%vs 94.87%,P>0.05),内镜治疗组的住院时间显著短于外科手术组[(11.26±5.93)d vs(20.00±13.44)d,P<0.05],且并发症更少、更轻。随访5~77个月,内镜治疗组有1例术后1年局部复发;外科手术组有2例分别出现局部淋巴结及远处转移。结论:内镜切除治疗GI-NENs疗效好、住院时间短、早期和远期并发症少且轻。对于直径<2 cm且不伴有局部或远处转移的GI-NENs,内镜切除可作为首选治疗方法。

Objective:To explore the endoscopic manifestations,diagnosis and treatment methods and prognostic factors of gastrointestinal neuroendocrine neoplasms(GI-NENs).Methods:In this study,we retrospectively analyzed 119 GI-NENs patients who underwent endoscopic surgery or surgical diagnosis and treatment in our hospital from January 2012 to December 2018.The endoscopic features and pathological stages were analyzed,and the treatment outcomes and prognosis were compared between two surgical prodecures.Results:A total of 119 cases of GI-NENs that met the criteria were included in this study.The most common lesion distribution was in the rectum(83 cases,69.75%),followed by the stomach(13 cases,10.92%)and duodenum(12 cases,10.08%).There were 54 cases with lesion diameter less than 1 cm,49 cases with 1 cm<diameter<2 cm,and 16 cases with diameter larger than 2 cm.All 119 patients underwent immunohistochemical examination of postoperative specimens,including 65 cases(82.3%)in G1 stage,54 cases(73.0%)in G2 stage,and 0(0%)in G3 stage.Totally 80 patients were treated under endoscopy,including 73 cases of G1 stage and 7 cases of G2 stage;39 patients were treated with surgical operation,including 28 cases of G1 stage and 11 cases of G2 stage.The complete resection rate in the endoscopic treatment group was not significantly different from the surgical group(93.75%,and 94.87%,P>0.05),but the hospitalization time in the endoscopic treatment group was significantly shorter than that in the surgical group(11.26±5.93 days,and 20.00±13.44 days,P<0.05),and the complications were less and milder in the endoscopic treatment group,including small perforation of the wound during the operation and intermittent abdominal pain;while the surgical patients had more serious complications,including intestinal anastomotic leakage and bleeding,intestinal infection and anal stenosis.During the follow-up period of 5-77 months,1 case in the endoscopic treatment group had local recurrence one year after surgery;2 cases in the surgical group had local lymph node and distant metastasis.Conclusion:Endoscopic resection for the treatment of GI-NENs has satisfactory curative effect,short hospital stay,and few early and long-term complications.For GI-NENs with a diameter of less than 2 cm and no local or distant metastases,endoscopic resection can be the first choice for treatment.