2024 年第 5 期 第 0 卷

牙线辅助内牵引下内镜黏膜下剥离术在直肠神经内分泌肿瘤中的应用效果观察

Application effect observation of floss assisted internal traction endoscopic submucosal dissection for rectal neuroendocrine neoplasms

作者：郎海波 张杰 王晓玥

英文作者：Lang Haibo Zhang Jie Wang Xiaoyue

单位：首都医科大学附属北京安贞医院消化内科，北京100029

英文单位：Department of Gastroenterology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：神经内分泌肿瘤；直肠；内镜黏膜下剥离术；牙线牵引

英文关键词：Neuroendocrineneoplasms;Rectum;Endoscopicsubmucosaldissection;Flosstraction

• 摘要：

• 目的  评估牙线辅助内牵引下内镜黏膜下剥离术(ESD)切除直肠神经内分泌肿瘤（NEN）的有效性和安全性。方法  收集2017年1月至2023年6月在首都医科大学附属北京安贞医院消化内科进行结肠镜检查并接受治疗的34例直肠NEN患者的资料进行回顾性分析。根据内镜手术方法将其分为牙线内牵引下ESD治疗组（10例）和传统ESD治疗组(24例)，比较2组患者的手术操作时间、手术并发症、术后组织病理、住院时间和住院费用等指标。结果  病变位于距肛门3～10 cm处，肿瘤直径3～12 mm，均为单发病灶，2组肿瘤最大径、完整切除率差异均无统计学意义（均P>0.05）。牙线内牵引下ESD治疗组的手术时间短于传统ESD治疗组［23.5(16.8，25.3)min比30.0(22.8，36.0)min］，差异有统计学意义（P=0.012）。传统ESD治疗组有2例（8.3%）出现术后并发症。所有患者均未累及固有肌层，无淋巴血管受累。牙线内牵引下ESD治疗组无一例术后病理显示肿瘤紧贴烧灼缘，而传统ESD治疗组有5例(20.8%)术后病理显示肿瘤紧贴烧灼缘。牙线内牵引下ESD治疗组住院时间短于传统ESD治疗组［6(5，7)d比8(7，11)d］，差异有统计学意义(P=0.002)，2组住院费用差异无统计学意义（P=0.326）。结论  牙线辅助内牵引下ESD治疗直肠NEN，手术方法便捷，有利于暴露手术视野，提高完整切除率，减少并发症。

• Objective  To evaluate the efficacy and safety of internal floss assisted traction endoscopic submucosal dissection(ESD) for rectal neuroendocrine neoplasms(NEN). Methods  The data of 34 patients with rectal NEN who underwent colonoscopy and received treatment at the Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University from January 2017 to June 2023 were retrospectively analyzed. According to the method of endoscopic surgery, the patients were divided into the dental floss traction ESD treatment group (10 cases) and the traditional ESD treatment group (24 cases). The operation time, surgical complications, postoperative histopathology, hospitalization time and hospitalization cost were compared between the two groups. Results  The lesion was located 3-10 cm away from the anus, with a tumor diameter of 3-12 mm. Both lesions were single lesions, and there was no significant difference in the maximum diameter of tumors and the complete resection rate between the two groups(both P>0.05). The operation time of the dental floss traction ESD treatment group was shorter than that of the traditional ESD treatment group［23.5(16.8,25.3)min vs 30.0(22.8,36.0)min］(P=0.012). There were 2 cases (8.3%) of postoperative complications in the traditional ESD treatment group. There was no involvement of muscularis propria and lymphatic vessels in all patients. No postoperative pathology showed that the tumor was close to the cauterization margin in the dental floss traction ESD treatment group, while the postoperative pathology showed that the tumor was close to the burning margin in 5 cases(20.8%) in the traditional ESD treatment group. The hospitalization time of the dental floss traction ESD treatment group was shorter than that of the traditional ESD treatment group［6(5,7)d vs 8 (7,11)d］(P=0.002). There was no significant difference in hospitalization cost between the two groups(P=0.326). ConclusionFloss assisted ESD in the treatment of rectal NEN is a convenient surgical method, which is conducive to exposing the surgical field, improving the complete resection rate and reducing complications.