钛夹牵引联合肌间层剥离治疗直肠神经内分泌肿瘤的临床研究

Clinical study of titanium clip traction plus intermuscular dissection for rectal neuroendocrine neoplasms

目的:评估钛夹牵引联合肌间层剥离对直肠神经内分泌肿瘤(NEN)的手术临床意义,推动直肠NEN(ESD)的流程化、标准化操作。方法:选取弋矶山医院2021年1月1日~2023年11月1日病例24例,根据NEN病灶大小,高低位配对设计联合组及常规组,其中联合组采取钛夹牵引联合肌间层剥离,常规组采用常规ESD法,比较两组切除时间、切除完整性等。结果:其中联合组13例,常规组11例。联合组手术时间(15.23±4.92)min;常规组手术时间(35.45±7.51)min,两组差异有统计学意义(P<0.01)。联合组完整手术切除率100%;常规组11例,完整切除7例,3例切缘可见肿瘤组织,1例过度电凝不能判断肿瘤切缘。结论:钛夹牵引联合肌间层剥离对直肠NEN行ESD的手术时间、完整切除率较传统ESD均有明显优势,且操作简单,可以作为直肠NEN行ESD的手术流程化、标准化操作方法。

Objective:To evaluate the clinical significance of titanium clip traction combined with intermuscular dissection in endoscopic treatment of rectal neuroendocrine neoplasms(NEN),and to facilitate endoscopic submucosal dissection(ESD)of rectal NEN in process-oriented and standardized fashion.Methods:The patients were paired into combined and conventional groups based on the size and location of the NEN lesions.The combined group underwent endoscopic intermuscular dissection plus titanium clip traction.Then the two groups were evaluated regarding the statistical differences in resection time and complete excision.Results:A total of 24 cases were included from the First Affiliated Hospital of Wannan Medical College between January 1,2021,and November 1,2023.Thirteen cases were in the combined group and 11 in the conventional group.The mean resection time was(15.23±4.92)min in the combined group and(35.45±7.51)min in the conventional group.The difference was significant between groups(P<0.001).The complete resection rate was 100%in the combined group.Of the 11 cases in the conventional group,7 had complete resection,3 had tumor tissue at the margin,and 1 had indeterminate tumor margins due to excessive electrocoagulation.Conclusion:Combined titanium clip traction with endoscopic intermuscular dissection shows significant advantages in resection time and complete resection rate for rectal NEN.This technique is simple,and can be process-oriented and standardized as the resection method for rectal NEN.