摘要
目的:探讨经超声肠镜联合内镜下黏膜下剥离术(ESD)治疗直肠神经内分泌瘤(RNET)的治疗效果及安全性。方法:收集粤北人民医院内镜中心因直肠黏膜下肿瘤行直肠ESD治疗、治疗后免疫组织化学证实为RNET的78例患者临床资料,针对患者的近期治疗效果及远期随访情况进行观察,统计术后并发症、死亡以及复发情况,观察术后切缘阳性,对于切缘可疑阳性与阳性的危险因素进行分析。结果:78例患者术后切缘可疑阳性与阳性例数18例(23.08%),术后1个月随访并发症发生率2.56%(2/78),中位随访时间5.24年,随访2例(2.56%)死亡,4例(5.13%)复发。对于术后切缘可疑阳性与阳性经单因素与多因素Logistic回归分析,年龄≥60岁(OR=1.456)、肿瘤病理分级高(OR=1.345)、有并发症(OR=1.554)、死亡(OR=1.725)均是独立危险因素。结论:对于RNET患者采取超声肠镜联合内镜下ESD术治疗的效果好,术后随访并发症发生率低,但存在一定死亡及复发情况,同时术后也存在切缘阳性,切缘阳性的影响因素多样,需根据情况予以对应干预以取得良好预后干预效果。
Objective To explore the therapeutic effect and safety of ultrasound colonoscopy combined with endoscopic submucosal dissection(ESD)in the treatment of rectal neuroendocrine tumors(RNETs).Method We collected clinical data from 78 patients who were diagnosed with rectal submucosal tumors and underwent rectal endoscopic submucosal dissection(ESD)at our hospital endoscopy center.All patients underwent ultrasound colonoscopy combined with ESD surgery.The diagnosis of rectal neuroendocrine tumor(RNET)was confirmed by immunohistochemistry after treatment.We analyzed the short-term efficacy and long-term follow-up outcomes of these patients.Additionally,we recorded postoperative complications,mortality,and recurrence rates.We also evaluated the presence of positive surgical margins and analyzed potential risk factors associated with positive or negative surgical margins.Results Among the 78 patients,18(23.08%)had suspicious positive surgical margins,and the incidence of complications was 2.56%(2/78)at 1-month follow-up.The median follow-up time for patients was 5.24 years,with 2(2.56%)deaths and 4(5.13%)relapses.For suspected positive or negative surgical margins after surgery,univariate and multivariate logistic regression analysis showed that age≥60 years old(OR=1.456),high tumor pathological grade(OR=1.345),presence of complications(OR=1.554),and death(OR=1.725)were all independent risk factors.Conclusion For RNET patients,the use of ultrasound colonoscopy combined with endoscopic ESD surgery has a good effect,with a low incidence of postoperative complications,but there is a certain degree of mortality and recurrence.At the same time,there are also cases of positive surgical margins after surgery.The influencing factors for positive surgical margins are diverse,and corresponding interventions need to be given according to the situation to achieve good prognosis intervention effects.
作者
陈姣艳
曹文波
陈斌
CHEN Jiao-Yan;CAO Wen-Bo;CHEN Bin(Department of Gastroenterology,North Guangdong People's Hospital,Shaoguan 512025,Guangdong,China)
出处
《吉林医学》
2025年第8期1821-1824,共4页
Jilin Medical Journal
基金
韶关市卫生健康局资助项目[项目编号:Y24006]。
关键词
直肠神经内分泌瘤
超声肠镜
内镜下黏膜下剥离术
安全性
危险因素
Rectal neuroendocrine tumor
Ultrasound colonoscopy
Endoscopic submucosal dissection
Clinical efficacy
Security
Risk factors
