Professional Documents
Culture Documents
内镜下黏膜切除术与内镜黏膜下剥离术治疗消化道神经内分泌肿瘤的对比研究
内镜下黏膜切除术与内镜黏膜下剥离术治疗消化道神经内分泌肿瘤的对比研究
内镜下黏膜切除术与内镜黏膜下剥离术治疗消化道神经内分泌肿瘤的对比研究
9
2017 年 9 月 China Journal of Endoscopy Sep. 2017
DOI: 10.3969/j.issn.1007-1989.2017.09.014
文章编号 :1007-1989(2017)09-0075-04
论 著
内镜下黏膜切除术与内镜黏膜下剥离术治疗消化道
神经内分泌肿瘤的对比研究
1 1 1 2
王保健 ,顾文芬 ,胡忠卓 ,薛林
(攀钢集团总医院 1. 消化内科 ;2. 病理科,四川 攀枝花 617023)
摘要 :目的 探讨内镜下黏膜切除术(EMR)和内镜黏膜下剥离术(ESD)对消化道神经内分泌肿瘤
患者围手术期临床指标、完全切除率及并发症的影响。方法 研究对象选取该院 2009 年 6 月 -2016 年 6 月
消化道神经内分泌肿瘤患者共 40 例,根据手术方案不同分为 A 组(20 例)和 B 组(20 例),分别采用 EMR
(A 组)
和 ESD(B 组)治疗,比较两组患者手术时间、治疗费用、病变组织直径、病变组织厚度、肿物完全切除率、
垂直切缘阴性率及并发症发生率等。结果 A 组患者手术时间和治疗费用均明显优于 B 组(P <0.05);两组
患者病变组织直径和厚度比较差异无统计学意义(P >0.05);B 组患者肿物完全切除率明显高于 A 组(P <0.05);
两组患者垂直切缘阴性率比较差异无统计学意义(P >0.05);B 组患者并发症发生率明显高于 A 组(P <0.05)。
结论 两种内镜术式治疗消化道神经内分泌肿瘤在肿物切除效果方面较为接近,EMR 具有操作时间短、经
济负担轻及并发症少等优势 ;而 ESD 应用则有助于提高肿物彻底清除效果。
关键词 : 内镜下黏膜切除术 ;内镜黏膜下剥离术 ;神经内分泌肿瘤
中图分类号 : R735 文献标识码 : A
Abstract: Objective To investigate the influence of EMR and ESD of endoscopic surgery on perioperative
clinical parameters, complete resection rate and complications of patients with neuroendocrine tumors of digestive
tract. Methods 40 patients with neuroendocrine tumors of digestive tract were chosen from June 2009 to June 2016
and randomly divided into 2 groups: A group (20 patients) with EMR and B group (20 patients) with ESD; and the
operation time, the treatment cost, the lesion size, the lesion thickness, the complete resection of tumor, the negative
rate of vertical margin and the complication incidence of the two groups were compared. Results The operation time
and the treatment cost of B group were significant better than A group (P < 0.05). There was no significant difference
in the lesion size and the lesion thickness between the two groups (P < 0.05). The completed resection rate of B group
were significant higher than A group (P < 0.05). There was no significant difference in the negative rate of vertical
margin between the two groups (P < 0.05). The complication incidence of B group were significant higher than A
group (P < 0.05). Conclusion EMR and ESD of endoscopic surgery in the treatment of patients with neuroendocrine
tumors of digestive tract possess the same clinical effects; EMR application can efficiently shorten the operation time
and decrease the economic burden and ESD application maybe helpful to reduce the complication risk.
收稿日期 :2017-06-12
· 75 ·
中国内镜杂志 第 23 卷
Keywords: endoscopic mucosal resection (EMR); endoscopic submucosal desection (ESD); neuroendocrine
tumors
· 76 ·
第9期 王保健,等:内镜下黏膜切除术与内镜黏膜下剥离术治疗消化道神经内分泌肿瘤的对比研究
表1 两组患者围手术期临床指标比较 (x ±s)
Table 1 Comparison of clinical index in peri-operative period between the two groups (x ±s)
(P <0.05)。见表 3。 关前瞻性研究证实。
EMR 术自上世纪 80 年代开始被应用于消化道小
表2 两组肿物完全切除率和垂直切缘阴性率比较 肿瘤切除,其术中侵袭损伤较传统开放手术更低,术
例(%) 后并发症明显降低
[8]
;ESD 术在内镜直视下以专用器
Table 2 Comparison of total resection rate and negative 械将病灶与下方正常黏膜完全剥离 ;而病变完全切除
margin of vertical resection between the two groups n(%) [9]
被认为是彻底治愈疾病和避免复发关键 。ESD 术式
组别 肿物完全切除率 垂直切缘阴性率 在完整剥离病灶方面具有优势,在提供全面病理诊断
A 组(n =20) 14(70) 19(95) 资料的同时,更有助于提高疾病彻底治愈率,降低远
[10]
B 组(n =20) 19(95) 18(90) 期复发风险 ;国外学者研究显示,ESD 手术治愈性
2
χ 值 8.26 1.14 切除率约为 75% ~ 95%,而穿孔率则低于 5%,且治
[11]
P值 0.013 0.526 疗费用较外科手术切除明显降低 ;
本次研究结果中,A 组患者手术时间和治疗费
表3 两组患者并发症发生率比较 例(%)
Table 3 Comparison of complication incidence between 用 分 别 为(8.82±1.70)min 和(2 130.83±476.25)
the two groups n (%) 元 ;B 组患者手术时间和治疗费用分别为(30.58±
4.66)min 和(5 708.54±968.02) 元 ;A 组 患 者 手
组别 术中出血 穿孔 迟发出血 并发症发生率
术时间和治疗费用均明显优于 B 组(P <0.05),提
A 组(n =20) 0 1 0 5
示 EMR 术应用于消化道神经内分泌肿瘤在缩短手术
B 组(n =20) 2 1 1 20
2
用时和减轻治疗费用方面具有优势,与既往报道基
χ 值 9.14
[12] [13]
本一致 ;DINC 等 认为 ESD 术后创面较 EMR 范
P值 0.006
围更大可能是导致手术时间延长主要原因,与笔者
想法一致。而 A 组患者病变组织直径和厚度分别为
3 讨论 (15.82±2.40) 和(0.28±0.04)mm ;B 组 患 者 病 变
人民健康体检意识提高和疾病检查技术进步使 组 织 直 径 和 厚 度 分 别 为(16.28±2.66) 和(0.31±
得消化道神经内分泌肿瘤检出率和检出例数均逐年 0.06)mm ;两组患者病变组织直径和厚度比较差异
· 77 ·
中国内镜杂志 第 23 卷
[1] KUANG S L, LI X L, YANG Y X. Endoscopic ultrasonography inflammatory process of the acetic acid-induced colitis in the rat
assisted endoscopic submucosal dissection for rectal carcinoid: an colonic mucosa[J]. Int Surg, 2015, 100(11-12): 1364-1374.
analysis of 38 cases[J]. Chinese Journal of Digestive Endoscopy, [14] CAPLIN M, SUNDIN A, NILLSON O, et al. ENETS Consensus
2015, 32(1): 50-52. Chinese Guidelines for the management of patients with digestive
[2] KIM H H, PARK S J, LEE S H, et al. Efficacy of endoscopic neuroendocrine neoplasms: colorectal neuroendocrine
submucosal resection with a ligation device for removing small neoplasms[J]. Neuroendocrinology, 2012, 95(2): 88-97.
rectal carcinoid tumor compared with endoscopic mucosal [15] SALYERS W J, VEGA K J, MUNOZ J C, et al. Neuroendocrine
resection: analysis of 100 cases[J]. Dig Endosc, 2012, 24(3): 159- tumors of the gastrointestinal tract case reports and literature
163. review[J]. World J Gastroenterol Oncol, 2014, 6(8): 301-310.
[3] GOTO O, URAOKA T, HORII J, et al. Expanding indications for [16] ZHANG X B, MA L, BAO H D, et al. Clinical pathological and
ESD: submucosal disease (SMT/ carcinoid tumors)[J]. Gastrointest prognostic characteristics of gastro entero pancreatic neuro
Endosc Clin N Am, 2014, 24(2): 169-181. endocrine neoplasms in China aretrospective study[J]. BMC
[4] 中国胃肠胰神经内分泌肿瘤病理专家组 . 中国胃肠胰神经内分 Endocr Disord, 2014, 14: 54.
(彭薇 编辑)
· 78 ·