摘要
目的:回顾性分析内镜下黏膜切除术(c-EMR)、内镜下改良黏膜切除术(m-EMR)以及内镜黏膜下剥离术(ESD)治疗<10 mm以及≥10 mm的直肠神经内分泌肿瘤(R-NEN)的有效性及安全性。方法:回顾性分析2012年5月至2022年5月江苏省苏北人民医院消化胃肠中心收治的120例R-NEN患者的临床资料及随访情况，比较内镜下不同术式治疗R-NEN的整块切除率、组织学完整切除率、术后并发症、手术时间及随访情况。结果:共纳入患者120例，24例行c-EMR、30例行m-EMR、66例行ESD。临床疗效对比：肿瘤直径<10 mm患者共79例，行c-EMR 16例、行m-EMR 18例、行ESD45例，三组整块切除率、组织学完整切除率比较均无明显统计学差异(P>0.05)。肿瘤直径≥10 mm患者共41例，行c-EMR8例、行m-EMR12例、行ESD21例，m-EMR及ESD组比c-EMR组组织学完整切除率更高，差异有统计学意义(P<0.05)。c-EMR组及m-EMR组比ESD组手术时间短，有统计学意义(P<0.05)。结论:对于R-NEN的内镜下治疗，c-EMR、m-EMR及ESD在治疗<10 mm的R-NEN中均具有安全性及有效性，但对于≥10 mm的R-NEN治疗建议选择m-EMR或ESD。无论选用何种术式治疗，术后规律性随访仍然重要。
Abstract
Objective:To retrospectively analyze the safety and efficacy of conventional-endoscopic mucosal resection(c-EMR), modified-endoscopic mucosal resection (m-EMR) and endoscopic submucosal dissection (ESD) in the treatment of <10 mm and ≥10 mm rectal neuroendocrine tumor (R-NEN).Methods:The total of 120 patients with R-NEN confirmed by postoperative pathological results who receive treatment in the Gastrointestinal Center of Northern Jiangsu People′s Hospital from May 2012 to May 2022 were selected as the study subjects. We retrospectively analyzed the en bloc resection rate, histological complete resection, operative complication, and time of different endoscopic procedures.Results:A total of 120 patients were included, of which 24 underwent c-EMR, 30 underwent m-EMR and 66 underwent ESD.There were 79 patients in the diameter<10 mm group, 16 patients underwent c-EMR, 18 patients underwent m-EMR, 45 patients underwent ESD. There were no significant differences in the en bloc resection rate and histological complete resection among the three groups (P>0.05). There were 41 patients in the diameter ≥10 mm group, 8 patients underwent c-EMR, 12 patients underwent m-EMR, 21 patients underwent ESD. The histological resection rate of m-EMR and ESD group was higher than that of c-EMR group, and the difference was statistically significant (P<0.05). The operation time of c-EMR and m-EMR group was shorter than that of ESD group among patients in the diameter <10 mm group and ≥10 mm group.Conclusion:C-EMR, m-EMR and ESD can effectively and safely resect R-NEN with tumor diameter <10mm, but m-EMR and ESD are recommended for ≥10 mm tumors. Follow-up is still important no matter which endoscopic procedure was chosen.
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