| ObjectiveTo evaluate the value of modified endoscopic submucosal dissection,a new endoscopic procedure,in the treatment of rectal neuroendocrine tumor and its clinical application.MethodsA retrospective analysis of the clinical data of 58 patients with rectal neuroendocrine tumor treated by ESD and m-ESD form February 2008 to June 2019 was conducted.To evaluate the value of two kinds of endoscopic treatment,indicators such as the time of tumor stripping,the rate of en bloc resection,he curative resection rate,the rate of healing,the rate of postoperative bleeding,perforation and local recurrence were compared.ResultsThere were no significant differences in age,sex,tumor size and distance from anal orifice among the two groups.General data:The ratio of male to female was about 1.5:1,male was more than female,51-60years old was the best age range to develop the disease.The average diameter of tumors was 0.8±0.3cm and 75.9%of the lesions are located in the middle rectum.44.8%of the Patients were diagnosed accidently due to routine physical examinations.16 Patients had colorectal polyps.94.8%of the lesions showed submucosal protuberance and 72.4%showed yellow color.Among the 34 cases who underwent endoscopic ultrasonography before operations,only one case was misdiagnosed as stromal tumor,the accuracy rate was 97.1%.The rate of en bloc resection was 100%in both groups.There was no significant differences in the complete resection rate(91.3%:97.1%)and the curative resection rate(65.2%:62.9%)between ESD group and m-ESD group.Operation Time:The average operation time in ESD group and m-ESD group were 1648.6±976.7(s)and 908.0±376.9(s),respectively,P<0.05.The lesions were divided into group<1cm and group ≥1.0cm.The results of self-comparison of each procedure were both P<0.05.The results of group<1cm and group group≥1.0cm were the same,ESD:m-ESD group(P<0.05).It has been proved in this study that the time of operation is not related to the surface depression of the lesions.Pathological results:52 cases(52/58,89.7%)were grade G1,6 cases(6/58,10.3%)were grade G2.The mean diameter of lesions in Grade G1 group was 0.7±0.3cm,and that in Grade G2 group was 1.1±0.4cm.The diameters of the two groups were examined by independent sample t test,and the result is P<0.05.Operative Safety Index:There were no perforation in this study.The incidence of operative complications were 7/23,30.4%in the ESD group,8/35,22.9%in the M-ESD group,the incidence rates were detected by chi-square test(P>0.05).8 cases of mild delayed hemorrhage,8 cases of slight abdominal pain and 1 case of fever occurred,all of them were relieved by medical conservative treatment.There was no difference in incidence rate between two groups.Follow-up results:A total of 44 patients were followed up,the follow-up rate was 75.9%.The follow-up time was from 3 months to 102 months,the median follow-up time was 30.5 months.No residual,recurrence or metastasis was found.ConclusionEndoscopic Treatment of rectal neuroendocrine tumor is safe and effective.M-ESD is as good as ESD in block resection,curative resection,safety and so on.After circumferential incision,the lesions were fully peeled off to form an artificial false pedicle,and the lesions were resected by high frequency electricity with the aid of a snare device.The operation time and the difficulty of peeling off lesions were reduced obviously.It is convenient and rapid that the specimens of the lesions could be taken out completely and directly after the operation.This study is a single-center,retrospective analysis,still need large multi-center samples and prospective experiments to further study and improve. |
PDF Full Text Request