超声内镜及ESD对直肠神经内分泌肿瘤的诊治意义

Clinical Significance of Endoscopic Ultrasonography and Endoscopic Mucosal Dissection in the Diagnosis and Treatment of Rectal Neuroendocrine Tumors

目的 回顾性分析超声内镜(endoscopic ultrasonography,EUS)及内镜下黏膜剥离术(endoscopic mucosal dissection,ESD)对直肠神经内分泌肿瘤(rectal neuroendocrine tumors,R-NET)的诊治意义。方法 选取2019年8月—2023年7月于莆田学院附属医院就诊的33例经电子结肠镜和EUS检查且经ESD治疗的R-NET患者进行临床特征和治疗效果分析。结果 33例患者中位于低位和中位的R-NET病灶分别占45.5%(15/33)和39.4%(13/33),66.7%(22/33)病灶最大直径<5 mm,54.5%(18/33)位于黏膜下层,经ESD术后病灶完全切除率达81.8%(27/33),余紧邻切缘占18.2%(6/33)。所有患者术后病理分级均为G1,术后3个月和6个月行电子结肠镜复查未见复发。免疫组化结果显示,突触素(synaptophysin,Syn)、CD56和细胞角蛋白(cytokeratin,CK)阳性率较高,嗜铬粒蛋白A(chromograninA,CgA)反而较低。结论 R-NET病灶小且隐匿,EUS可助其全面评估;ESD对R-NET患者的诊治效果好、安全性高。

Objective The clinical significance of endoscopic ultrasonography(EUS)and endoscopic mucosal dissection(ESD)in the diagnosis and treatment of rectal neuroendocrine tumors(R-NET)was retrospectively analyzed.Methods A total of 33 R-NET patients who underwent electronic colonoscopy and EUS examination and were treated with ESD from August 2019 to July 2023 in the Affiliated Hospital of Putian University were selected for clinical characteristics and therapeutic effects analysis.Results In the 33 patients,45.5%(15/33)and 39.4%(13/33)of R-NET lesions were located in the low and middle areas,respectively.66.7%(22/33)had the largest lesion diameter<5 mm,54.5%(18/33)were located in the submucosa.The complete resection rate of the lesion after ESD was 81.8%(27/33),and 18.2%(6/33)were adjacent to theresection margin.The pathological grade of all patients was G1,and no recurrence was observed by electronic colonoscopy at 3 and 6 months after surgery.Immunohistochemical results showed higher positive rates of synaptophysin(Syn),CD56 and cytokeratin(CK),but lower positive rates of chromograninA(CgA).Conclusion R-NET lesions are small and insidious.EUS can be used for comprehensive evaluation of lesions.ESD has good therapeutic effect and high safety on R-NET.