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陈 樑 梁 玮.透明帽辅助下内镜黏膜切除术与内镜黏膜下剥离术对直肠神经内分泌肿瘤疗效分析[J].中国现代医生,2021,59(30):39-43
透明帽辅助下内镜黏膜切除术与内镜黏膜下剥离术对直肠神经内分泌肿瘤疗效分析
Analysis of the efficacy of cap-assisted endoscopic mucosal resection and endoscopic submucosal dissection in the treatment of rectal neuroendocrine tumors
  
DOI:
中文关键词:  直肠神经内分泌肿瘤  内镜下透明帽辅助下黏膜切除术  内镜黏膜下剥离术  并发症
英文关键词:Rectal neuroendocrine tumor  Endoscopic cap-assisted mucosal resection  Endoscopic submucosal dissection  Complications
基金项目:福建医科大学启航基金项目(2018QH1146)
作者单位
陈 樑 梁 玮 福建省立医院消化内镜中心福建福州 350000 
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中文摘要:
      目的 回顾性分析透明帽辅助下内镜黏膜切除术(EMR-C)及内镜黏膜下剥离术(ESD)对治疗直肠神经内分泌肿瘤直径<7 mm 与≥7 mm 安全性及有效性。方法 选取2014 年1 月至2018 年12 月福建省立医院消化内镜中心行内镜下透明帽辅助下黏膜切除术(EMR-C)和内镜黏膜下剥离术(ESD),术后病理结果证实为直肠神经内分泌肿瘤的110 例患者作为研究对象,根据直径大小分为直径<7 mm 组(n=65)及直径7~15 mm 组(n=45),比较两组间行EMR-C 和ESD 治疗直肠神经内分泌肿瘤的整块切除、组织学完全切除及并发症情况。结果 直径<7 mm 组及肿瘤直径≥7 mm 组中,EMR-C 及ESD 两组性别、年龄、类癌直径、距肛门齿状线距离比较,差异无统计学意义(P>0.05)。直径<7 mm 组共65 例,其中行EMR-C 31 例,整块切除29 例(93.5%),组织学完全切除29 例(93.5%),术后出血1 例(3.2%)。行ESD 34 例,整块切除31 例(91.2%),组织学完全切除31 例(91.2%),术后2 例出血(5.8%)。直径<7 mm 组中,EMR-C 及ESD 两组的整块切除、组织学完全切除及并发症情况比较,差异均无统计学意义(P>0.05)。肿瘤直径7~15 mm 组共45 例,20 例行EMR-C,整块切除11 例(55.0%),组织学完全切除13 例(65.0%),术后出血1 例(5.0%)。25 例行ESD 中,整块切除24 例(96.0%),组织学完全切除24 例(96.0%),术后出血1 例(4.0%)。直径7~15 mm 组中,EMR-C 组与ESD 组整块切除率、完全切除率比较,差异有统计学意义(P<0.05),术后并发症比较,差异无统计学意义(P>0.05)。手术成功随访92 例(83.6%),均无复发、转移及死亡。结论 肿瘤直径<7 mm 的直肠神经内分泌肿瘤EMR-C 与ESD 均能有效且安全切除,而≥7 mm 者,ESD 完全切除率明显高于EMR-C,建议应用ESD。
英文摘要:
      Objective To retrospectively analyze the safety and efficacy of cap-assisted endoscopic mucosal resection(EMR-C)and endoscopic submucosal dissection(ESD)in the treatment of rectal neuroendocrine tumors <7 mm and≥7 mm in diameter.Methods A total of 110 patients with rectal neuroendocrine tumors confirmed by postoperative pathological results who underwent EMR-C and ESD in the Digestive Endoscopy Center of Fujian Provincial Hospital from January 2014 to December 2018 were selected as the study subjects.They were divided into two groups according to the diameter:the diameter <7 mm group(n=65)and the diameter 7-15 mm group(n=45).The en bloc resection,histologically complete resection,and complications of rectal neuroendocrine tumors treated with EMR-C and ESD were compared between the two groups.Results There was no significant difference in sex,age,tumor diameter,and distance from the anal dentate line between EMR-C and ESD groups(P>0.05).There were 65 patients in the diameter <7 mm group.Thirty-one patients underwent EMR-C,among whom 29 patients(93.5%)underwent en bloc resection,29 patients(93.5%)underwent complete histological resection,and one patient(3.2%)had postoperative bleeding.ESD was performed in 34 patients,among whom 31 patients(91.2%)underwent en bloc resection,31 patients(91.2%)underwent complete histological resection,two patients(5.8%)postoperative bleeding.There was no significant difference in en bloc resection,histologically complete resection,and complications between EMR-C and ESD groups with diameter <7 mm(P>0.05).There were 45 cases in the tumor diameter 7-15 mm group.Twenty cases underwent EMR-C,11 cases(55.0%)underwent en bloc resection,13 cases(65.0%)underwent complete histological resection,and 1 case(5.0%)had postoperative bleeding.Of the 25 patients who underwent ESD,24 cases(96.0%)had enbloc resection,24 cases(96.0%)had a complete histological resection,and 1 case(4.0%)had postoperative bleeding.There were significant differences in the en bloc resection rate and complete resection rate between EMR-C and ESD(P<0.05).However,there was no significant difference in postoperative complications(P>0.05).Ninety-two patients(83.6%)were successfully followed up,all of whom had no recurrence,metastasis,or death.Conclusion Both EMR-C and ESD can effectively and safely resect rectal neuroendocrine tumors with tumor diameter <7 mm.While for patients ≥7 mm,the complete resection rate of ESD is significantly higher than that of EMR-C.ESD is recommended.
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