摘要
目的:对比内镜下新型金属夹联合圈套器辅助内镜下黏膜切除术(CS-EMR)与内镜黏膜下剥离术(ESD)切除方法治疗直径约10 mm以下直肠神经内分泌瘤(NET)的疗效分析。方法:回顾性分析2019年9月至2022年9月南京市高淳人民医院消化科收治的43例直肠神经内分泌瘤患者，其中，男23例、女20例，平均年龄(54.27±11.48)岁。按手术方式分为两组：ESD组27例、CS-EMR组16例；行相关检查治疗后，术后病理证实NET。其中，27例采用ESD术切除、16例采取CS-EMR术切除；对比两组患者病灶大小、切除面积大小、切除时间、术后病理评估等情况。结果:CS-EMR组与ESD组两组比较，手术切除面积分别为(46.75±14.65)mm2及(185.96±117.33)mm2，P<0.05、手术操作时间为(13.69±3.95)min及(40.26±8.93)min，P<0.05具有显著差异。R0切除，垂直切缘、垂直切缘、血管、淋巴管、神经侵犯、术后并发症发生率、术后追加手术均无明显差异(P>0.05)。结论:对于位于直肠的无淋巴结转移的直径<1 cm的类癌，CS-EMR、ESD法均为安全有效方法。新型CS-EMR法操作相对简单，手术操作时间和术后住院时间短优势；相比ESD方法并未增加术后切缘阳性及术后追加手术比率。
Abstract
Objective:To compare the efficacy of two different endoscopic resection methods in the treatment of rectal neuroendocrine tumors (NET) less than 10mm in diameter.Methods:A total of 43 cases of rectal submucosal tumors from September 2019 to September 2022 were retrospectively collected. After relevant examination and treatment in our hospital, postoperative pathological findings of rectal neuroendocrine tumors were confirmed.27 cases were resected by ESD and 16 cases by CS-EMR. The size of lesion, resection area, resection time and postoperative pathological evaluation were compared between the two groups.Results:The surgical resection area of CS-EMR group and ESD group was (46.75±14.65) mm2 and (185.96±117.33)mm2, respectively P<0.05, operation time (13.69±3.95)min compared with (40.26±8.93) min, P<0.05, there were significant differences.There were no significant differences in R0 resection, vertical resection margin, vascular, lymphatic, nerve invasion, incidence of postoperative complications, and postoperative additional operation (P>0.05).Conclusion:Both CS-EMR and ESD methods are safe and effective for carcinoids with a diameter of less than 1 cm located in the rectum without lymph node metastasis. New-style(CS-EMR) method is relatively simple to operate, and has advantages of short operation time and postoperative hospital stay. Compared with ESD method, there was no increase in the rate of positive postoperative margin and postoperative additional surgery.
基金项目
江苏卫生健康职业学院校级科研项目(JKC202007)
万方数据