经肛门内镜显微手术治疗直肠神经内分泌肿瘤

doi:10.3877/cma.j.issn.1674-6899.2016.04.003

中华腔镜外科杂志(电子版) ›› 2016, Vol. 09 ›› Issue (04) : 200 -203. doi: 10.3877/cma.j.issn.1674-6899.2016.04.003

所属专题：文献；

论著

经肛门内镜显微手术治疗直肠神经内分泌肿瘤

陆君阳¹, 林国乐¹^,^†(

), 邱辉忠¹

^1. 100730　北京，中国医学科学院　北京协和医学院　北京协和医院基本外科

收稿日期:2016-05-10 出版日期:2016-08-30
通信作者: 林国乐

Treatment of rectal neuroendocrine tumors by transanal endoscopic microsurgery

Junyang Lu¹, Guole Lin¹^,^†(), Huizhong Qiu¹

^1. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China

Received:2016-05-10 Published:2016-08-30
Corresponding author: Guole Lin
About author:
Corresponding author: Lin Guole, Email: linguole@126.com

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目的

探讨经肛门内镜显微手术 (TEM)直肠全层切除治疗直肠神经内分泌肿瘤的效果。

方法

回顾性分析北京协和医院2006年12月至2015年12月间74例采用TEM治疗的直肠神经内分泌肿瘤患者。收集患者的一般资料、肿瘤特点、手术情况、术后病理及随访结果。

结果

其中50例患者行原发病灶切除，24例患者因结肠镜下切除后标本切缘不清或阳性行二次手术。肿瘤直径平均 (1.02 ± 0.43)cm，距离肛缘 (7.9 ± 1.7)cm。平均手术时间 (58.7 ± 12.1)min，平均术中出血量 (13.1 ± 5.0)ml。所有标本基底和侧切缘均阴性。平均随访3.6年，无肿瘤复发。

结论

TEM可以作为直径较小的中上段直肠神经内分泌肿瘤手术治疗的首选。

关键词: 经肛门内镜显微手术, 直肠神经内分泌肿瘤, 全层切除

Objective

To assess the efficacy of full-thickness excision using transanal endoscopic microsurgery (TEM) in the treatment of rectal neuroendocrine tumors.

Methods

We analyzed the data of seventy four rectal neuroendocrine tumor patients who underwent TEM between Dec.2006 and Dec. 2015 at our department. Data collected included patient demographics, tumor characteristics, operative details, postoperative outcomes, pathologic findings, and follow-ups.

Results

TEM was performed as a primary excision (n=50) or as complete surgery after incomplete resection by endoscopic polypectomy (n=24). The mean size of the primary tumor was (1.02 ± 0.43)cm, and the mean distance of the tumor from the anal verge was (7.9 ± 1.7)cm. The mean duration of the operation was (58.7 ± 12.1)min, and the mean blood loss was (13.1 ± 5.0)ml. Histopathologically, all tumors showed typical histology, and both deep and lateralsurgical margins were completely free of tumors.No recurrence was noted during the median of 3.6 years′ follow-up.

Conclusions

Full-thickness excision using TEM could be a first surgical option for complete removal of middle-upper small rectal neuroendocrine tumors.

Key words: Transanal endoscopic microsurgery, Rectal neuroendocrine tumor, Full-thickness excision

表1 经肛门内镜显微手术患者的两组一般资料及肿瘤特点比较

组别	例数	男性/女性(例数)	年龄(岁)	肿瘤大小(cm)	位置(前壁/后壁) (例数)	距离肛缘(cm)
初次手术组	50	26/24	51.2(24～70)	1.11±0.48	19/31	7.7±1.6
二次手术组	24	13/11	52.3(35～76)	0.84±0.23	10/14	8.4±1.8
P值		0.861	0.234	0.031	0.762	0.772

表1 经肛门内镜显微手术患者的两组一般资料及肿瘤特点比较

组别	例数	男性/女性(例数)	年龄(岁)	肿瘤大小(cm)	位置(前壁/后壁) (例数)	距离肛缘(cm)
初次手术组	50	26/24	51.2(24～70)	1.11±0.48	19/31	7.7±1.6
二次手术组	24	13/11	52.3(35～76)	0.84±0.23	10/14	8.4±1.8
P值		0.861	0.234	0.031	0.762	0.772

图1 经肛门内镜显微手术全层切除直肠神经内分泌肿瘤

表2 经肛门内镜显微手术患者的两组手术及病理结果比较

组别	例数	手术时间(min)	术中出血量(ml)	住院时间(d)	切除标本大小(cm)	浸润深度(黏膜/黏膜下/肌层)(例数)	肿瘤分级(G1级/G2级)(例数)
初次手术组	50	60.1±9.9	13.0±5.0	3.3±1.8	2.3±0.6	30/14/6	38/12
二次手术组	24	54.8±15.3	13.5±5.4	3.0±1.2	2.3±0.5	4/6/0	8/2
P值	?	0.122	0.530	0.083	0.562	－	－

表2 经肛门内镜显微手术患者的两组手术及病理结果比较

组别	例数	手术时间(min)	术中出血量(ml)	住院时间(d)	切除标本大小(cm)	浸润深度(黏膜/黏膜下/肌层)(例数)	肿瘤分级(G1级/G2级)(例数)
初次手术组	50	60.1±9.9	13.0±5.0	3.3±1.8	2.3±0.6	30/14/6	38/12
二次手术组	24	54.8±15.3	13.5±5.4	3.0±1.2	2.3±0.5	4/6/0	8/2
P值	?	0.122	0.530	0.083	0.562	－	－

1	Tsikitis VL, Wertheim BC, Guerrero MA. Trends of incidence and survival of gastrointestinal neuroendocrine tumors in the United States: a seer analysis [J]. J Cancer, 2012, 3 (1): 292-302.
2	Scherübl H. Rectal carcinoids are on the rise: early detection by screening endoscopy [J]. Endoscopy, 2009, 41(2): 162-165.
3	Caplin M, Sundin A, Nillson O, et al.ENETS Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms: colorectal neuroendocrine neoplasms [J]. Neuroendocrinology, 2012, 95 (2): 88-97.
4	Maeda K, Maruta M, Utsumi T, et al. Minimally invasive surgery for carcinoid tumors in the rectum [J]. Biomed Pharmacother, 2002, 56 (1): 222-226.
5	Kwaan MR, Goldberg JE, Bleday R. Rectal carcinoid tumors: review of results after endoscopic and surgical therapy [J]. Arch Surg, 2008, 143 (5): 471-475.
6	邱辉忠，林国乐，周皎琳，等. 经肛门内镜微创手术在治疗局限性直肠肿瘤中的应用 [J]. 中华外科杂志，2009, 47 (13): 981-983.
7	Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13 715 carcinoid tumors [J]. Cancer, 2003, 1597 (4): 934-959.
8	Shields CJ, Tiret E, Winter DC. International Rectal Carcinoid Study Group. Carcinoid tumors of the rectum: a multi-institutional international collaboration [J]. Ann Surg, 2010, 252 (5): 750-755.
9	Onozato Y, Kakizaki S, Iizuka H, et al.Endoscopic treatment of rectal carcinoid tumors [J]. Dis Colon Rectum, 2010, 53 (2): 169-176.
10	Soga J. Early-stage carcinoids of the gastrointestinal tract: an analysis of 1914 reported cases [J]. Cancer, 2005, 103 (8): 1587-1595.
11	林国乐，邱辉忠，肖毅，等. 腹腔镜内镜微创手术治疗高龄结直肠癌患者[J/CD]. 中华腔镜外科杂志：电子版，2013, 6 (6): 402-405.
12	Demartines N, von Flüe MO, Harder FH.Transanal endoscopic microsurgical excision of rectal tumors: indications and results[J]．World J Surg, 2001, 25 (7): 870-875.
13	Laliberte AS, Lebrun A, Drolet , et al.Transanal endoscopic microsurgery as an outpatient procedure is feasible and safe [J]. Surg Endosc, 2015, 29 (12): 3454-3459.
14	Flexer SM, Durham-Hall AC, Steward MA, et al. TEMS: results of a specialist centre [J]. Surg Endosc, 2014, 28 (6): 1874-1878.
15	林国乐，邱辉忠，周皎琳，等. 经S肛门内镜微创手术的适应证与并发症 [J]．中华结直肠疾病电子杂志，2015, 4 (5): 521-525.
16	Ramwell A, Evans J, Bignell M, et al. The creation of a peritoneal defect in transanal endoscopic microsurgery does not increase complications [J]. Colorectal Dis, 2009, 11 (9): 964-966.

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