内镜黏膜下剥离术与改良内镜黏膜切除术对G1期直肠神经内分泌瘤的疗效对比分析

Comparison of efficacy between endoscopic submucosal dissection and modified‑endoscopic mucosal resection for G1 rectal neuroendocrine tumors

目的比较内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)与改良内镜黏膜切除术(modified‑endoscopic muscosal resection,M‑EMR)对G1期直肠神经内分泌瘤(rectal neuroendocrine tumors,RNETs)的疗效。方法回顾性分析2017年1月至2020年9月于南京鼓楼医院行ESD(n=105)或M‑EMR(n=16)治疗且病理证实为G1期RNETs的121例患者临床资料,采用逆处理概率加权法(inverse probability of treatment weighting,IPTW),对比两组患者完整切除率、并发症发生率、住院时间、治疗费用等指标。结果ESD组和M‑EMR组肿瘤数目(χ^(2)=8.76,P=0.003)、浸润深度(χ^(2)=6.96,P=0.008)、使用金属夹比例[82.9%(87/105)比93.8%(15/16),χ^(2)=8.78,P=0.003]、使用金属夹数目(χ^(2)=8.41,P=0.016)、使用热钳止血比例[78.1%(82/105)比18.7%(3/16),χ^(2)=20.64,P<0.001]、牵引比例[2.9%(3/105)比18.7%(3/16),χ^(2)=4.45,P=0.035]、治疗总费用[(17568.6±8911.0)元比(8120.8±1528.2)元,t=3.65,P<0.001]差异均有统计学意义。采用IPTW敏感性分析验证结果稳定性后,治疗总费用(t=2.07,P<0.001)差异仍有统计学意义。结论ESD和M‑EMR治疗G1期RNETs患者疗效相当,但M‑EMR治疗费用更低。

Objective To compare the efficacy of endoscopic submucosal dissection(ESD)and modified‑endoscopic mucosal resection(M‑EMR)for G1 rectal neuroendocrine tumors(RNETs).Methods Data of 121 patients with pathologically confirmed G1 RNETs treated with ESD(n=105)or M‑EMR(n=16)in Nanjing Drum Tower Hospital from January 2017 to September 2020 were retrospectively analyzed.The complete resection rate,complication incidence,hospital stay,treatment cost and other indicators of the two groups were compared by using inverse probability of treatment weighting(IPTW).Results There were significant differences in tumor number(χ^(2)=8.76,P=0.003),tumor invasion depth(χ^(2)=6.96,P=0.008),utilization of metal clips[82.9%(87/105)VS 93.8%(15/16),χ^(2)=8.78,P=0.003],number of metal clips(χ^(2)=8.41,P=0.016),hemostasis using hot clamp[78.1%(82/105)VS 18.7%(3/16),χ^(2)=20.64,P<0.001],traction procedure[2.9%(3/105)VS 18.7%(3/16),χ^(2)=4.45,P=0.035]and treatment cost(17568.6±8911.0 yuan VS 8120.8±1528.2 yuan,t=3.65,P<0.001)between the ESD group and the M‑EMR group.After verifying the stability of the results using IPTW sensitivity analysis,there was still significant difference in the treatment cost(t=2.07,P<0.001).Conclusion Both ESD and M‑EMR demonstrate comparable efficacy in treating G1 RNETs;however,M‑EMR exhibites lower treatment costs.