直肠神经内分泌肿瘤病人ESD术后不完整切除及标本垂直切缘阳性影响因素分析

靳迎春; 周津; 赵金

doi:10.13898/j.cnki.issn.1000-2200.2022.10.015

直肠神经内分泌肿瘤病人ESD术后不完整切除及标本垂直切缘阳性影响因素分析

Analysis of factors influencing the incomplete resection of rectal neuroendocrine tumor and positive vertical margin of specimen after ESD

摘要

摘要:
目的分析直肠神经内分泌肿瘤病人内镜黏膜下剥离术(ESD)术后不完整切除及标本垂直切缘阳性影响因素。
方法选取125例直肠神经内分泌肿瘤病人作为研究对象，均行ESD治疗，根据手术治疗效果，将其分为完整切除组(n=89)与不完整切除组(n=36)，其中不完整切除组出现15例标本垂直切缘阳性，采用多因素logistic回归分析影响ESD术后不完整切除的相关因素，以及标本垂直切缘阳性的影响因素。
结果ESD术后不完整切除单因素分析显示，性别、年龄、隆起形态与ESD术后不完整切除相关性无统计学意义(P>0.05)；肿瘤直径、浸润深度、病变表面黏膜中央凹陷与ESD术后不完整切除相关有统计学意义(P<0.01)。多因素logistic回归分析显示，肿瘤直径>1.5 cm/1~1.5 cm、浸润深度为黏膜下层、病变表面有黏膜中央凹陷均是影响ESD术后不完整切除的独立危险影响因素(P<0.05~P<0.01)。标本垂直切缘阳性单因素分析显示，性别、年龄、隆起形态与标本垂直切缘阳性无相关性(P>0.05)；病变直径、病变形态、核分裂像与标本垂直切缘阳性有相关性(P<0.05)。多因素logistic回归分析显示，影响ESD治疗后垂直切缘阳性的危险因素为病变直径≥10 mm(P<0.05)。
结论肿瘤直径>1.5 cm、浸润至黏膜下层、病变表面黏膜存在中央凹陷、标本垂直切缘阳性说明直肠神经内分泌肿瘤病人经ESD治疗后存在较高的不完整切除风险；而病变直径≥10 mm提示ESD治疗后垂直切缘阳性高风险，临床应加强评估及随访，从而为后续治疗提供参考依据。

Abstract:
ObjectiveTo analyze the factors influencing the incomplete resection of rectal neuroendocrine tumor patients after endoscopic submucosal dissection(ESD) and the the positive vertical margin of the specimen.
MethodsOne hundred and twenty-five patients with rectal neuroendocrine tumors were selected as the research objects.All of them underwent ESD treatment.According to the effect of surgical treatment, they were divided into the complete resection group(n=89) and the incomplete resection group(n=36).Among them, 15 cases of specimens in the incomplete resection group had positive vertical margins.Binary logistic regression was used to analyze the related factors that affect incomplete resection after ESD affecting the positive vertical margin and the positive vertical resection margin of the specimen.
ResultsThe univariate analysis of incomplete resection after ESD showed that gender, age, and bulge shape were not significantly correlated with incomplete resection after ESD(P>0.05).Tumor diameter, depth of infiltration, central depression on the surface of the lesion and ESD after operation incomplete resection was significantly correlated with incomplete resection after ESD(P<0.01).Binary logistic regression analysis showed that tumor diameter>1.5 cm/1-1.5 cm, infiltration depth of submucosa, and central mucosa on the surface of the lesion were independent risk factors affecting incomplete resection after ESD(P<0.05).A univariate analysis of the positive vertical margin of the specimen showed that gender, age, and swelling shape were not significantly correlated with the positive vertical margin of the specimen(P>0.05).The lesion diameter, lesion shape, mitotic image were significantly related to the positive vertical margin of the specimen(P<0.05).Binary logistic regression analysis showed that tumor diameter>1.5 cm/1-1.5 cm, infiltration depth of submucosa and central mucosa on the surface of the lesion was independent risk factors affected the incomplete resection after ESD(P<0.05).
ConclusionsTumor diameter>1.5 cm, infiltration into the submucosa, central depression on the surface of the lesion and positive vertical margins of the specimen indicate that patients with rectal neuroendocrine tumors have the higher risk of incomplete resection after ESD treatment.Lesions diameter ≥10 mm indicates that there is a high risk of positive vertical margins after ESD treatment.The clinical evaluation and follow-up should be strengthened to provide reference for the subsequent treatment.

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