Clinical research of endoscopic ultrasonography-guided endoscopic submucosal dissection in the treatment of patients with rectal neuroendocrine tumor
Objective To investigate the clinical efficacy of endoscopic ultrasonography(EUS)-guided endoscopic submucosal dissection(ESD)in the treatment of patients with rectal neuroendocrine tumor(RNET).Method Sixty RNET patients were selected,all patients underwent EUS-guided ESD treatment and followed up for 1 year.The EUS ex-amination results,ESD treatment and follow-up of all patients were recorded.The quality of life[quality of life scale for gastrointestinal neuroendocrine tumors-21(QLQ-GI.NET21)]and serum tumor markers[carcinoembryonic antigen(CEA),neuronal specific enolase(NSE),carbohydrate cancer antigen 19-9(CA19-9)and chromogranin A(CGA)]levels of RNET patients before and after treatment were compared.Result A total of 67 lesions were detected in 60 patients.EUS showed that 4 lesions were from the mucosal layer,5 lesions from the mucosal myometria,and 58 lesions from the submucosal layer.Five lesions were>10 cm from the anus,28 lesions were≤10 cm and>5 cm from the anus,and 34 lesions were<5 cm from the anus.All 60 patients were treated with ESD,and the mean operation time was(30.86±9.86)min,the mean diameter of lesions was(0.82±0.26)cm.Complete resection was achieved in 62 lesions,and the bas-al margin of the other 5 lesions were positive(all of which were treated with additional surgery during the operation),with a complete resection rate of 92.54%(62/67).The results of postoperative pathological examination showed that 63 lesions were G1 grade and 4 lesions were G2 grade.Postoperative hemorrhage occurred in 5 patients,3 patients underwent endoscopic hemostasis with titanium clamp,and 2 patients received conservative treatment with drugs.After treatment,the dimensional scores of QLQ-GI.NET21 and serum NSE,CEA,CGA and CA19-9 levels of RNET patients were signifi-cantly lower than those before treatment,and the differences were statistically significant(P<0.01).No recurrence and/or metastasis occurred in 60 patients during follow-up.Conclusion EUS can clearly display RNET lesions,and can effec-tively guide ESD treatment.EUS-guided ESD in the treatment of RNET has certain effectiveness and safety.
NETL
NSTL
万方数据
