C型切开法内镜黏膜下剥离术在直肠神经内分泌肿瘤中的应用研究

Application of C‑type incision to endoscopic submucosal dissection for the treatment of rectal neuroendocrine tumors

摘要:

目的 评价C型切开法内镜黏膜下剥离术（C‑type endoscopic submucosal dissection， C‑ESD）治疗直肠神经内分泌肿瘤（neuroendocrine tumors，NEN）的临床效果。方法 回顾性分析2018年1月—2021年7月期间在福建省泉州市第一医院内窥镜室行ESD治疗的55例直肠NEN患者资料，按治疗方案分为C‑ESD组（28例）与传统ESD组（27例），比较两组剥离时间、剥离速度、黏膜下层注射次数、整块切除率、治愈性切除率及术后并发症发生率情况。结果 两组基本资料比较差异均无统计学意义（P>0.05）。C‑ESD组剥离时间（13.8±4.2）min，传统ESD组为（19.9±3.9） min，差异有统计学意义（t=5.649，P<0.001）；C‑ESD组剥离速度（0.08±0.04）cm2/min，快于传统ESD组的（0.06±0.04）cm2/min （t=2.218，P=0.031）；C‑ESD组黏膜下注射次数2（1，2）次，少于传统ESD组的3（2，3）次，差异有统计学意义（Z=-8.701，P<0.001）。两组病灶均整块切除。C‑ESD组治愈性切除率100.0%（28/28），传统ESD组为88.9%（24/27），差异有统计学意义（P=0.011）。传统ESD组术后发生7例并发症，其中1例迟发性出血，5例迟发性穿孔和1例固有肌层损伤，C‑ESD组无相关并发症发生，差异有统计学意义（P=0.004）。结论 C‑ESD治疗结直肠NEN可缩短剥离时间，提高剥离速度，减少黏膜下层注射次数，提高治愈性切除率，减少并发症，是一种安全有效的治疗策略。

Abstract:

Objective To evaluate the clinical efficacy of C‑type endoscopic submucosal dissection (C‑ESD) for rectal neuroendocrine tumors (NEN). Methods The retrospective analysis was performed on data of 55 patients who underwent ESD for rectal NEN at the Department of Endoscopy in Quanzhou First Hospital from January 2018 to July 2021. Patients were divided into the C‑ESD group (n=28) and the conventional ESD group (n=27). The dissection time, the dissection speed, the number of submucosal injections, the enbloc resection rate, the curative resection rate and the rate of postoperative complications of the two groups were compared. Results There were no statistically significant differences in basic information between the two groups (P>0.05). The dissection time was 13.8±4.2 min in the C‑ESD group and 19.9±3.9 min in the conventional ESD group with statistically significant difference (t=5.649, P<0.001). The dissection speed in the C‑ESD group was 0.08±0.04 cm2/min, which was faster than 0.06±0.04 cm2/min in the conventional ESD group (t=2.218, P=0.031). The number of submucosal injections in the C‑ESD group was less than that in the conventional ESD group [2 (1, 2) VS 3 (2, 3), Z=-8.701, P<0.001]. The lesions were enbloc resected in both groups. The curative resection rate in the C‑ESD group was 100.0% (28/28) and 88.9% (24/27) in the conventional ESD group with statistically significant difference (P=0.011). There were 7 cases of postoperative complications in the conventional ESD group, including 1 delayed bleeding, 5 delayed perforation and 1 muscularis propria injury, while no postoperative complications occurred in the C‑ESD group (P=0.004). Conclusion C‑ESD is a safe and effective treatment strategy for colorectal NEN, which can shorten the dissection time, improve the dissection speed, reduce the number of submucosal injections, improve the curative resection rate, and reduce complications.