作者：吕国恩1，王楠方1，何东添2，谭翠1，彭丽芳1

单位：1.江门市中心医院窥镜中心，广东 江门 529030；2.江门市中心医院普通外科，广东 江门 529030

Authors: Lyu Guo’en1, Wang Nanfang1, He Dongtian2, Tan Cui1, Peng Lifang1

Unit: 1.Endoscopy Center, Jiangmen Central Hospital, Jiangmen 529030, Guangdong, China；2.Department of General Surgery, Jiangmen Central Hospital, Jiangmen 529030, Guangdong, China

摘要：

目的 探讨内镜切除与经肛手术切除在治疗直径为10~20 mm 的直肠神经内分泌肿瘤（neuroendocrine tumors, NETs）中的临床疗效和安全性差异。方法 回顾性分析2015年1月至2021年12月在江门市中心医院接受内镜切除或经肛手术切除治疗的66例直径为10~20 mm的直肠NETs患者的临床资料，其中经肛手术切除组32例，内镜切除组34例。通过比较两组的基线资料、围手术期情况、病理结果、随访复发及生存状况等数据，评估两种手术方式的安全性、肿瘤根治性、无复发生存率及总体生存率。结果 内镜切除组的手术时间[（37.7±12.3）min 比（67.9±18.2）min]、术中出血量[（18.1±10.9）ml 比（34.4±11.3）ml]及术后住院时间[（3.2±0.5）d 比（6.0±1.5）d]均优于经肛手术切除组（P<0.001）。两组的围手术期并发症发生率（内镜切除组11.8%比经肛手术切除组6.2%）、肿瘤完整切除率（内镜切除组85.3%比经肛手术切除组93.8%）差异无统计学意义（P>0.05）。内镜切除组与经肛手术切除组的3年无复发生存率分别为94.1%和87.5%，3年总体生存率分别为100%和96.9%，差异无统计学意义（P>0.05）。结论 对于直径为10~20 mm的直肠NETs，内镜切除和经肛手术切除均为有效且安全的治疗方法。内镜切除在术后恢复及手术操作时间方面具有优势，而经肛手术切除在处理深部浸润肿瘤时可能更加适合。

关键词： 直肠神经内分泌肿瘤；内镜切除；经肛手术；疗效；安全性

Abstract：

Objective  To explore the differences in clinical efficacy and safety between endoscopic resection and transanal resection in the treatment of rectal neuroendocrine tumors (NETs) with a diameter of 10-20 mm. Method  A retrospective analysis was conducted on the clinical data of 66 patients with rectal NETs of 10-20 mm in diameter who underwent endoscopic resection or transanal resection at Jiangmen Central Hospital from January 2015 to December 2021. There were 32 cases in the transanal resection group and 34 cases in the endoscopic resection group. By comparing the baseline data, perioperative conditions, pathological results, follow-up recurrence, and survival status of the two groups, the safety, tumor radicality, recurrence-free survival rate, and overall survival rate of the two surgical methods were assessed. Result  The operation time in the endoscopic resection group [(37.7±12.3) min vs. (67.9±18.2) min], intraoperative blood loss [(18.1±10.9) ml vs. (34.4±11.3) ml], and postoperative hospital stay [(3.2±0.5) d vs. (6.0±1.5) d] were all superior to the transanal resection group (P<0.001). There was no statistically significant difference in the incidence of perioperative complications (11.8% in the endoscopic resection group vs. 6.2% in the transanal resection group) and the rate of complete tumor resection (85.3% in the endoscopic resection group vs. 93.8% in the transanal resection group) between the two groups (P>0.05). The 3-year recurrence-free survival rates were 94.1% for the endoscopic resection group and 87.5% for the transanal resection group, and the 3-year overall survival rates were 100% and 96.9%, respectively, with no statistically significant differences (P>0.05). Conclusion  For rectal NETs with a diameter of 10-20 mm, both endoscopic resection and transanal resection are effective and safe treatment methods. Endoscopic resection has advantages in postoperative recovery and surgical operation time, while transanal resection may be more suitable for dealing with deeply infiltrating tumors.

Key Words: Rectal neuroendocrine tumors; Endoscopic resection; Transanal excision; Efficacy; Safety