作者：梁宇通1，邹文书1，吕国恩1，陈秋连1，孙丽霞2，蒋文川3，谭翠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 病理科，广东 江门 529030； 3.江门市中心医院 胃肠外科，广东 江门 529030

Authors:  LIANG Yutong1, ZHOU Wenshu1, LV Guoen1, CHEN Qiulian1, SUN Lixia2, JIANG Wenchuang3, TAN Cui1

Unit:  1.Endoscopy center, Jiangmen Central Hospital, Jiangmen 529030, Guangdong, China； 2.Department of Pathology, Jiangmen Central Hospital, Jiangmen 529030, Guangdong, China； 3.Department of Gastrointestinal Surgery, Jiangmen Central Hospital, Jiangmen 529030, Guangdong, China

摘要：

目的  探讨内镜粘膜下剥离术(endocsopic submucosal dissection, ESD)治疗胃肠神经内分泌肿瘤(gastrointestinal neuroendocrine neoplasms, GI-NENs)的临床疗效及安全性。方法  回顾性分析2015年1月至2018年12月间32例行ESD手术的GI-NENs患者,分析ESD的疗效及手术的安全性。结果 32例患者中肿瘤平均直径为0.93 cm,其中28例(87.5%)病例肿瘤局限于黏膜层,4例(12.5%)局限于黏膜下层。G1、G2期的患者分别有19例、13例。所有GI-NENs的患者均顺利进行ESD治疗。ESD操作过程中并无发生穿孔和出血的手术并发症。完整切除率比例是96.9%(31/32)。术后发生延迟性出血仅2例(6.2%)。在随访期间内,仅有1例患者出现ESD术后局部复发,并无患者发生肿瘤相关性死亡。结论  ESD治疗GI-NENs患者是安全、有效及可行的,然而ESD治疗GINENs是适应征在将来的临床工作中尚需要进一步探讨。

关键词： 胃肠神经内分泌肿瘤; 内镜下黏膜下切除; 临床疗效; 安全性

Abstract：

Objective  The incidence of gastrointestinal neuroendocrine neoplasms was rapidly increasing year by year because of the frequent use of endoscopic screening. However, the clinical outcome of endocsopic submucosal dissection (ESD) for GI-NENs were still unclear. Therefore, we aimed to assess the clinical outcome and safety of ESD for GI-NENs. Methods  Between January 2015 and December 2018, 32 cases of GI-NENs who underwent ESD were retrospectively analyzed. The therapeutic outcomes from ESD and procedure-related complications were evaluated. Results  Among 32 patients, the median tumor size was 0.93 cm in diameter. 28 lesions (87.5%) were confined to the mucosa and 4 cases (87.5%) were located in the submucosal layer. There were 19 cases of G1 stage and 13 cases of G2 stage, and no G3 stage was found in our study. All patients achieved successfully ESD for GI-NENs. Surgical complications such as perforation and bleeding did not occur during ESD procedure. The rate of en-bloc resection, negative for both lateral and vertical margins was 100% and 96.9% respectively for ESD. Moreover, the postoperative bleeding rates was 6.2% (2/32). Among the follow-up period, one of 32 patients had tumor local recurrence after ESD and there was no case of disease-related death. Conclusions  ESD was an effective, safe and feasible treatment strategy for GI-NENs. However, the indication of ESD for GI-NENs should be carefully evaluated in the near future.

Key Words:  Gastrointestinal neuroendocrine neoplasms; Endocsopic submucosal dissection; Clinical outcome; Safety