直肠神经内分泌肿瘤的内镜精查特征及内镜下切除治疗效果

Characteristics of Endoscopic Precision Examination and the Efficacy of Endoscopic Resection Treatment for Rectal Neuroendocrine Tumors

目的探讨直肠神经内分泌肿瘤的内镜精查特征,并观察患者接受内镜下切除治疗的效果及安全性。方法选取2020年1月至2024年1月在新乡医学院第一附属医院接受治疗的60例直肠神经内分泌肿瘤患者,记录患者的内镜精查特征。采用信封法对患者进行分组:30例患者接受内镜下黏膜剥离术(ESD)治疗,纳入ESD组,30例患者接受内镜下黏膜切除术(EMR)治疗,纳入EMR组,比较其病变切除情况、临床手术资料、生存质量及并发症发生情况。结果60例直肠神经内分泌肿瘤患者中男性占比较高,年龄多为60岁以下,肿瘤多大于5 mm,距离肛门位置较远,WHO分类为G1级。ESD组治愈性切除率及整块切除率均高于EMR组(P<0.05),但组间基底病灶残余率差异无统计学意义(P>0.05)。ESD组手术时间、术后住院时间长于EMR组,创面直径大于EMR组(P<0.05),但组间切除标本直径及厚度差异无统计学意义(P>0.05)。治疗前两组生活质量评分差异无统计学意义(P>0.05),治疗后7 d两组生活质量评分均较治疗前降低,且ESD组低于EMR组(P<0.05)。两组术后迟发性出血、穿孔、皮下气肿、局部复发及感染的发生率差异无统计学意义(P>0.05)。结论直肠神经内分泌肿瘤患者多数年龄<60岁,男性占比较高,肿瘤多数≥5 mm,距离肛门位置多数≥5 cm以及免疫组化结果显示Syn阳性患者占比较高;ESD治疗可提高治愈性切除率、整块切除率及生存质量,但患者的手术时间、术后住院时间较EMR延长,创面直径较大,因此应根据临床实际灵活选择治疗方案。

Objective To explore the characteristics of endoscopic endoscopy of rectal neuroendocrine tumors and observe the efficacy and safety of patients undergoing endoscopic resection.Methods This study was conducted in 60 patients with rectal neuroendocrine tumors treated in the First Affiliated Hospital of Xinxiang Medical College from January 2020 to January 2024,and the characteristics of endoscopic precision examination were recorded.Patients were grouped using envelope method,30 patients received endoscopic submucosal dissection(ESD)treatment and were included in the ESD group,while 30 patients received endoscopic mucosal resection(EMR)treatment and were included in the EMR group,and their lesion resection,clinical surgical data,quality of life and complications were recorded.Results Among the 60 patients with rectal neuroendocrine tumors,the male proportion was relatively high,the age was under 60 years old,the tumor size was more than 5 mm,and far away from the anus,and the WHO classification was G1.The curative resection rate and whole piece resection rate of ESD group were higher than those of EMR group(P<0.05),but there was no statistical difference in the residual rate between groups(P>0.05).Operation time and postoperative hospital stay of ESD group were longer than EMR group,and wound diameter was greater than EMR group(P<0.05),but there was no statistical difference in specimen diameter and thickness(P>0.05).There was no statistically difference in the quality of life scores between the two groups before treatment(P>0.05).After 7 days of treatment,the quality of life scores in both groups decreased compared to before treatment,and ESD group was lower than EMR group(P<0.05).There was no statistically difference in the incidence of postoperative delayed bleeding,perforation,subcutaneous emphysema,local recurrence,and infection between the two groups(P>0.05).Conclusion The majority of patients with rectal neuroendocrine tumors are under 60 years old,with a higher proportion of males.The tumor size is mostly≥5 mm,and the distance from the anus is mostly≥5 cm.Immunohistochemical results show a higher proportion of Syn positive patients.ESD treatment can improve the curative resection rate,overall resection rate,and quality of life,but the patient’s surgical time and postoperative hospitalization time are longer than EMR,and the wound diameter is larger.Therefore,the treatment plan should be flexibly selected according to clinical practice.