套扎法内镜下黏膜切除术在直肠神经内分泌肿瘤中的应用

陈功, 孙超, 柴海娜, 吴莹莹, 王璐, 陈超伍, 汤东, 刘军

陈功, 孙超, 柴海娜, 吴莹莹, 王璐, 陈超伍, 汤东, 刘军. 套扎法内镜下黏膜切除术在直肠神经内分泌肿瘤中的应用[J]. 实用临床医药杂志, 2022, 26(18): 21-25. DOI: 10.7619/jcmp.20221529
引用本文: 陈功, 孙超, 柴海娜, 吴莹莹, 王璐, 陈超伍, 汤东, 刘军. 套扎法内镜下黏膜切除术在直肠神经内分泌肿瘤中的应用[J]. 实用临床医药杂志, 2022, 26(18): 21-25. DOI: 10.7619/jcmp.20221529
CHEN Gong, SUN Chao, CHAI Haina, WU Yingying, WANG Lu, CHEN Chaowu, TANG Dong, LIU Jun. Application of endoscopic mucosal ligation resection in rectal neuroendocrine tumors[J]. Journal of Clinical Medicine in Practice, 2022, 26(18): 21-25. DOI: 10.7619/jcmp.20221529
Citation: CHEN Gong, SUN Chao, CHAI Haina, WU Yingying, WANG Lu, CHEN Chaowu, TANG Dong, LIU Jun. Application of endoscopic mucosal ligation resection in rectal neuroendocrine tumors[J]. Journal of Clinical Medicine in Practice, 2022, 26(18): 21-25. DOI: 10.7619/jcmp.20221529

套扎法内镜下黏膜切除术在直肠神经内分泌肿瘤中的应用

基金项目: 

江苏省青年医学重点人才依托项目 QNRC2016330

江苏省扬州市重点研发计划(社会发展)项目 YZ2018087

详细信息
    通讯作者:

    刘军, E-mail: sbyy_liujun@163.com

  • 中图分类号: R735.3;R61

Application of endoscopic mucosal ligation resection in rectal neuroendocrine tumors

  • 摘要:
    目的 

    比较套扎法内镜下黏膜切除术(EMR-b)和内镜下黏膜剥离术(ESD)对直肠神经内分泌肿瘤(NENs)的治疗效果。

    方法 

    回顾性分析56例接受ESD或EMR-b治疗的直肠NENs患者的资料,患者肿瘤直径均 < 10 mm且无淋巴系统转移。根据接受治疗的不同,将患者分为EMR-b组26例和ESD组30例。记录2组患者组织学完整切除率、并发症发生率和操作时间。

    结果 

    56例患者的平均年龄为(51.05±11.31)岁。EMR-b组肿瘤直径为(7.12±2.76) mm, ESD组为(7.47±2.32) mm, 2组肿瘤直径差异无统计学意义(P=0.599)。EMR-b组切除时间为(9.08±3.45) min, 短于ESD组的(18.50±3.25) min, 差异有统计学意义(P < 0.001)。EMR-b组完整切除率为92.31%(24/26), ESD组为93.33%(28/30), 2组完整切除率差异无统计学意义(P=1.000)。非完整切除患者随访期间无局部复发和远处转移。

    结论 

    与ESD相比, EMR-b有相似的组织学完整切除率,但切除时间更短,操作更简单, EMR-b对于直径 < 10 mm、不超过黏膜下层的直肠NENs是一种良好的内镜下治疗方法。

    Abstract:
    Objective 

    To compare the efficacy of endoscopic mucosal resection using band ligation(EMR-b) and endoscopic mucosal dissection(ESD) in the treatment of rectal neuroendocrine tumors(NENs).

    Methods 

    The data of 56 rectal NENs patients with rectal NENs < 10 mm in diameters, without lymphatic metastasis treated by ESD or EMR-b were retrospectively analyzed. According to different treatments, the patients were divided into EMR-B group (26 cases) and ESD group (30 cases). The complete resection rate, incidence of complications, and length of procedures were compared between the two groups.

    Results 

    The mean age was (51.05±11.31) years old of 56 cases. The tumor size of EMR-B group was (7.12±2.76) mm, and was (7.47±2.32) mm in the ESD group, and the between-group difference in tumor size showed no significant difference (P=0.599). The resection time in EMR-B group was (9.08±3.45) min, which was shorter than (18.50±3.25) min in the ESD group, and the difference was statistically significant(P < 0.001). The complete resection rate of the EMR-B group was 92.31% (24/26), and was 93.33% (28/30) in the ESD group, and the difference was not statistically significant (P=1.000). In the cases of incomplete resection, there was neither local recurrence nor distant metastasis during the follow-up.

    Conclusion 

    Compared with ESD, EMR-b has similar histological complete resection rate, but has shorter resection time and simpler operation. EMR-b may be a better choice for rectal NENs with diameter < 10 mm and without invasion of submucosa.

  • 图  1   EMR-b治疗操作过程

    A: 直肠NENs内镜下表现; B: 超声内镜提示病变起源于黏膜下层; C: 黏膜下注射后用橡皮筋结扎病变; D: 在橡皮筋下方切圈套下切除; E: 术后创面; F: 切除后标本。

    图  2   ESD操作过程

    A: 直肠NENs内镜下表现; B: 超声内镜提示病变起源于黏膜下层; C: 标记病变范围; D: 内镜下剥离病变; E: 剥离后的创面; F: 剥离后标本固定。

    表  1   2组患者基本情况及肿瘤基本特征(x±s)[n(%)]

    指标 EMR-b组(n=26) ESD组(n=30) 全组(n=56) P
    年龄/岁 49.04±11.71 52.80±10.85 51.05±11.31 0.210
    12(46.15) 18(60.00) 30(53.57) 0.421
    肿瘤直径/mm 7.12±2.76 7.47±2.32 7.30±2.52 0.599
    距肛门距离/cm 5.81±1.92 6.73±2.78 6.30±2.44 0.153
    住院时间/d 3.27±0.60 4.83±0.79 4.11±1.06 < 0.001
    手术费用/元人民币 2 752.69±686.88 8 481.57±1 218.38 5 821.73±3 051.02 < 0.001
    下载: 导出CSV

    表  2   2组内镜治疗效果比较(x±s)[n(%)]

    指标 EMR-b组(n=26) ESD组(n=30) 全组(n=56) P
    完整切除 24(92.31) 28(93.33) 52(92.86) 1.000
    水平切缘阳性 0 1(3.33) 1(1.80) 1.000
    垂直切缘阳性 1(3.85) 1(3.33) 2(3.57) 1.000
    切缘均阳性 1(3.85) 0 1(1.79) 0.464
    切除时间/min 9.08±3.45 18.50±3.25 14.13±6.30 < 0.001
    迟发出血 0 1(3.33) 1(1.79) 1.000
    下载: 导出CSV
  • [1]

    WANG X Y, CHAI N L, LINGHU E Q, et al. Efficacy and safety of hybrid endoscopic submucosal dissection compared with endoscopic submucosal dissection for rectal neuroendocrine tumors and risk factors associated with incomplete endoscopic resection[J]. Ann Transl Med, 2020, 8(6): 368. doi: 10.21037/atm.2020.02.25

    [2]

    OSAGIEDE O, HABERMANN E, DAY C, et al. Factors associated with worse outcomes for colorectal neuroendocrine tumors in radical versus local resections[J]. J Gastrointest Oncol, 2020, 11(5): 836-846. doi: 10.21037/jgo-20-193

    [3]

    AVENEL P, MCKENDRICK A, SILAPASWAN S, et al. Gastrointestinal carcinoids: an increasing incidence of rectal distribution[J]. Am Surg, 2010, 76(7): 759-763. doi: 10.1177/000313481007600736

    [4]

    SHIM K N, YANG S K, MYUNG S J, et al. Atypical endoscopic features of rectal carcinoids[J]. Endoscopy, 2004, 36(4): 313-316. doi: 10.1055/s-2004-814202

    [5]

    CAPLIN M, SUNDIN A, NILLSON O, et al. ENETS Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms: colorectal neuroendocrine neoplasms[J]. Neuroendocrinology, 2012, 95(2): 88-97. doi: 10.1159/000335594

    [6]

    BASUROY R, HAJI A, RAMAGE J K, et al. Review article: the investigation and management of rectal neuroendocrine tumours[J]. Aliment Pharmacol Ther, 2016, 44(4): 332-345. doi: 10.1111/apt.13697

    [7]

    ONO A, FUJⅡ T, SAITO Y, et al. Endoscopic submucosal resection of rectal carcinoid tumors with a ligation device[J]. Gastrointestinal Endoscopy, 2003, 57(4): 583-587. doi: 10.1067/mge.2003.142

    [8]

    NAGAI T, TORISHIMA R, NAKASHIMA H, et al. Saline-assisted endoscopic resection of rectal carcinoids: cap aspiration method versus simple snare resection[J]. Endoscopy, 2004, 36(3): 202-205. doi: 10.1055/s-2004-814248

    [9]

    FUJISHIRO M, YAHAGI N, KAKUSHIMA N, et al. Outcomes of Endoscopic Submucosal Dissection for Colorectal Epithelial Neoplasms in 200 Consecutive Cases[J]. Clinical Gastroenterology and Hepatology, 2007, 5(6): 678-683. doi: 10.1016/j.cgh.2007.01.006

    [10]

    TANAKA S, OKA S, KANEKO I, et al. Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization[J]. Gastrointestinal Endoscopy, 2007, 66(1): 100-107. doi: 10.1016/j.gie.2007.02.032

    [11]

    CHOI C W, KANG D H, KIM H W, et al. Comparison of endoscopic resection therapies for rectal carcinoid tumor: endoscopic submucosal dissection versus endoscopic mucosal resection using band ligation[J]. J Clin Gastroenterol, 2013, 47(5): 432-436. doi: 10.1097/MCG.0b013e31826faf2b

    [12]

    SOLCIA E, KLÖPPEL G, SOBIN L H. Histological Typing of Endocrine Tumours[M]. Heidelberg: Springer, 2000: 115-119.

    [13]

    HE L, DENG T, LUO H. Efficacy and safety of endoscopic resection therapies for rectal carcinoid tumors: a meta-analysis[J]. Yonsei Med J, 2015, 56(1): 72-81. doi: 10.3349/ymj.2015.56.1.72

    [14]

    SOGA J. Carcinoids of the rectum: an evaluation of 1271 reported cases[J]. Surg Today, 1997, 27(2): 112-119. doi: 10.1007/BF02385898

    [15]

    KWAAN M R, GOLDBERG J E, BLEDAY R. Rectal carcinoid tumors: review of results after endoscopic and surgical therapy[J]. Arch Surg, 2008, 143(5): 471-475. doi: 10.1001/archsurg.143.5.471

    [16]

    LEE J, PARK Y E, CHOI J H, et al. Comparison between cap-assisted and ligation-assisted endoscopic mucosal resection for rectal neuroendocrine tumors[J]. Ann Gastroenterol, 2020, 33(4): 385-390.

    [17]

    MASHIMO Y, MATSUDA T, URAOKA T, et al. Endoscopic submucosal resection with a ligation device is an effective and safe treatment for carcinoid tumors in the lower rectum[J]. J Gastroenterol Hepatol, 2008, 23(2): 218-221. doi: 10.1111/j.1440-1746.2008.05313.x

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出版历程
  • 收稿日期:  2022-05-12
  • 网络出版日期:  2022-10-23
  • 刊出日期:  2022-09-22

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