目的 回顾性分析透明帽辅助的内镜黏膜下切除术(endoscopic mucosal resection with a cap,EMR-C)及内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗直肠神经内分泌肿瘤(neuroendocrine tumors,NETs)的效果差异.方法 收集2012年1月至2016年12月在解放军第306医院接受EMR-C(27例)或ESD(15例)治疗的42例直肠NETs患者.分析两组患者在整块切除率、病理完整切除率、根治性切除率、手术时间、并发症、随访复发率等方面的差异.结果 EMR-C组和ESD组的肿瘤平均大小分别为(5.1 ± 1.2)mm和(6.8 ± 2.1)mm(P=0.013),整块切除率分别为92.6%和100%(P=0.280),水平切缘阳性均为0,垂直切缘阳性率分别为11.1%和13.3%(P=0.831),脉管浸润率分别为0和6.7%(P=0.174),根治性切除率分别为81.5%和80.0% (P=0.907),手术时间分别为(5.83 ± 1.32)min和(31.43 ± 8.12)min(P<0.001),并发症发生率分别为7.4%和13.3%(P=0.531),随访均未见局部复发及转移.结论 EMR-C是一种简单、安全、有效的直肠NETs内镜治疗方法.%Objective To analyze the curative effect of endoscopic mucosal resection with a cap (EMR-C) and en-doscopic submucosal dissection (ESD) in the treatment of rectal neuroendocrine tumors (NETs).Methods Forty-two lesions in 42 patients with NETs who received EMR-C or ESD treatment in the 306th Hospital of PLA from Jan. 2012 to Dec. 2016 were included in the study. Endoscopic en bloc resection rate, pathologic complete resection rate, curative resection rate,procedure time,complication and occurrence were compared between EMR-C group (n=27) and ESD group (n=15).Results Mean tumor size was(5.1 ± 1.2) mm in the EMR-C group and(6.8 ± 2.1) mm in the ESD group (P=0.013). The rates of en bloc resection, positive for lateral margins, positive for vertical margins, lympho-vascular invasion and curative resection were 92.6%, 0, 11. 1%, 0 and 81. 5 % in EMR-C group, 100%, 0, 13.3%,6.7%, and 80.0% in ESD group, respectively. There were no significance differences between two groups (P>0.05). Mean procedure time was significantly longer in the ESD group(31.43 ± 8.12) min than that in the EMR-C group (5.83 ± 1.32) min(P<0.001).Complications such as perforation and bleeding occurred in both groups,but there was no significant difference(P=0.531). All patients were carefully followed-up,and so far,no obvious recurrence was found. Conclusion EMR-C may be a simple,safe and efficient method for resecting small rectal NETs.
展开▼
