内镜下治疗胃肠道神经内分泌肿瘤40例

摘要

目的 评价超声内镜及内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗胃肠道神经内分泌肿瘤(gastrointestinal neuroendocrine neoplasms,GI-NENs)的临床价值. 方法 我院2011年5月~2016年5月采用ESD 治疗GI-NENs 40例(食管1例,胃2例,十二指肠1例,阑尾1例,结肠2例,直肠33例),先在内镜下对病灶边缘进行环形标记,然后用甘油果糖靛胭脂肾上腺素稀释液黏膜下注射后环周切开,最后沿固有肌完整剥离切除肿物. 结果 40例术前超声内镜检查病变均局限于黏膜层至黏膜下层,术后病理示1例侵及肌层,超声内镜术前判断病变累及层次的正确率为97.5%(39/40).术中术后无出血、穿孔等并发症.术后病理完整切除率为97.5%(39/40),G1级34例,G2级6例.33例随访平均30.4月(2~56个月),均未见局部复发和远处转移. 结论 GI-NENs好发于直肠,以G1和G2级常见.ESD是治疗高分化神经内分泌瘤安全有效的方法,超声内镜能有效指导手术方案的选择.%Objective To evaluate the value of endoscopic ultrasonography and endoscopic submucosal dissection in the treatment of gastrointestinal neuroendocrine tumors. Methods A total of 40 patients with gastrointestinal neuroendocrine neoplasms between May 2011 and May 2016 were treated with endoscopic submucosal dissection.The submucosa was injected with glycerin fructose indigo carmine and adrenaline diluent.Subsequently, the mucosa was incised outside the marking dots.Direct dissection of the submucosal layer beneath the tumor was then performed under direct vision to achieve complete en bloc resection of the specimen. Results Preoperative endoscopic ultrasonography showed lesions located in the mucosa layer or submucosa layer in all the 40 cases and postoperative pathological examinations showed muscle layer involved in 1 case.The accuracy of the preoperative depth determination with endoscopic ultrasonography was 97.5%(39/40).No bleeding or perforation occurred during and after operation. The pathological complete resection rate was 97.5%(39/40).There were 34 cases of grade G1 and 6 cases of grade G2.Follow-up examinations for a mean of 30.4 months(range,2-56 months)in 33 cases found no recurrence or distant metastasis. Conclusions Gastrointestinal neuroendocrine neoplasms are prone to locate in the rectum, usually at grade G1 and G2.Endoscopic submucosal dissection is an effective treatment for gastrointestinal neuroendocrine tumors.Endoscopic ultrasonography is helpful to determine appropriate treatment.