异物钳辅助内镜黏膜切除术治疗长径≤10 mm直肠神经内分泌瘤的疗效分析（含视频）

Efficacy of endoscopic mucosal resection with grasping forceps for rectal neuroendocrine tumors ≤10 mm (with video)

摘要:

目的 对比异物钳辅助内镜黏膜切除术（endoscopic mucosal resection with grasping forceps ， EMR‑G）和内镜黏膜下剥离术（endoscopic submucosal dissection， ESD）切除长径≤10 mm直肠神经内分泌瘤的治疗效果。方法 回顾性分析2020年8月至2024年6月在汕头市中心医院内镜中心收治的74例长径≤10 mm直肠神经内分泌瘤患者资料，按手术方式分为ESD组和EMR‑G组，对比两组患者术后标本R0切除率、切缘距肿瘤底部距离、手术操作时间、手术费用、住院时间等指标。结果 EMR‑G组R0切除率高于ESD组［100.0%（37/37）比81.1%（30/37），χ²=7.731， P=0.006］。术后标本切缘EMR‑G组较为平整，且距肿瘤底部距离更远，EMR‑G组中位距离为330 μm，ESD组中位距离为110 μm，差异有统计学意义（Z=-5.890， P<0.001）。EMR‑G组手术时间（15.22±2.94）min，ESD组手术时间（27.95±6.50） min，差异有统计学意义（t=-10.854，P<0.001）。EMR‑G组费用（2 409.51±205.00）元，ESD组费用（7 899.19±420.14）元，差异有统计学意义（t=-71.430，P=0.001）。EMR‑G组术后住院时间（1.08±0.27）d，ESD组术后住院时间（2.76±0.80）d，差异有统计学意义（t=-12.095，P<0.001）。结论 EMR‑G治疗长径≤10 mm直肠神经内分泌瘤，可提高R0切除率，缩短手术时间，节省手术费用，减少术后住院时间，具有推广价值。

Abstract:

Objective To compare the efficacy of endoscopic mucosal resection with grasping forceps (EMR-G) and endoscopic submucosal dissection (ESD) for the resection of rectal neuroendocrine tumors (NET)≤10 mm. Methods Data of 74 patients with ≤10 mm rectal NET admitted to Shantou Central Hospital from August 2020 to June 2024 were retrospectively analyzed. Patients were divided into the ESD group and the EMR-G group according to the surgical method. Outcomes included R0 resection rate, margin-to-base distance, operative time, cost, and hospital stay. Results The EMR-G group demonstrated significantly higher R0 resection rates [100.0% (37/37) VS 81.1% (30/37), χ²=7.731, P=0.006], greater margin-to-base distance (median 330 μm VS 110 μm, Z=-5.890, P<0.001), shorter operative time (15.22±2.94 min VS 27.95±6.50 min, t=-10.854, P<0.001), lower cost (2 409.51±205.00 yuan VS 7 899.19±420.14 yuan, t=-71.430, P=0.001), and reduced hospital stay (1.08±0.27 days VS 2.76±0.80 days, t=-12.095, P<0.001). Conclusion EMR-G outperforms ESD for ≤10 mm rectal NETs by improving R0 resection, shortening procedure duration and hospitalization, and reducing costs, which is worth promotion.