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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2022, Vol. 11 ›› Issue (02) : 163 -167. doi: 10.3877/cma.j.issn.2095-3224.2022.02.012

经验交流

10 mm~20 mm非转移性直肠神经内分泌肿瘤完整切除率的多因素分析
朱信强1, 黄海龙2, 蒋学通1, 邢春根3,†()   
  1. 1. 223800　徐州医科大学附属宿迁医院普外科；215004　苏州大学附属第二医院普外科
    2. 223800　徐州医科大学附属宿迁医院普外科
    3. 215004　苏州大学附属第二医院普外科
  • 收稿日期:2021-08-11 出版日期:2022-04-25
  • 通信作者: 邢春根
  • 基金资助:
    2019年度宿迁市产业发展引导资金（科技创新专项———重点研发计划）(S201913)

Multifactor analysis of complete resection rate of 10 mm~20 mm nonmetastatic rectal neuroendocrine tumor

Xinqiang Zhu1, Hailong Huang2, Xuetong Jiang1, Chungen Xing3,†()   

  1. 1. Department of General Surgery, the Affiliated Suqian Hospital of Xuzhou Medical University, Suqian 223800, China
    3. Department of General Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
  • Received:2021-08-11 Published:2022-04-25
  • Corresponding author: Chungen Xing
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朱信强, 黄海龙, 蒋学通, 邢春根. 10 mm~20 mm非转移性直肠神经内分泌肿瘤完整切除率的多因素分析[J]. 中华结直肠疾病电子杂志, 2022, 11(02): 163-167.

Xinqiang Zhu, Hailong Huang, Xuetong Jiang, Chungen Xing. Multifactor analysis of complete resection rate of 10 mm~20 mm nonmetastatic rectal neuroendocrine tumor[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2022, 11(02): 163-167.

目的

探讨10 mm~20 mm非转移性直肠神经内分泌肿瘤组织完整切除率的影响因素。

方法

回顾分析徐州医科大学附属宿迁医院普外科和消化科2008年1月至2019年4月收治的直肠神经内分泌肿瘤患者的医院数据库数据，总结因素特点，对比分析内镜黏膜下切除与经肛切除组织完整性的影响因素，将有意义的因素，进行多因素分析，找出其独立危险因素。

结果

在24例患者中，诊断的中位年龄为43岁（29~58岁），62.5%为男性。距肛缘的中位距离为6.2 cm（3 cm~15 cm）。中位肿瘤直径大小为11.7 mm（10 mm~20 mm）。12例（50%）患者肿瘤浸润局限于黏膜层，有12例侵及黏膜下层。19例（79.17%）继续接受结肠镜随访，中位随访时间为37.3个月（3.5~113.0）。经肛局部切除组13例，完整切除率84.62%。内镜黏膜下切除11例，手术完整切除率54.55%。两组资料对比，术前超声肿块浸润深度、组织完整性切除，差异有统计学意义（χ2=2.542，2.663；P=0.028，0.046），对组织学切除完整性的比较，单因素分析侵犯深度、肿瘤大小、G分期、镜下表现是影响切除与否的危险因素，将有意义的单因素进行多因素分析，得出肿瘤浸润深度和肿瘤大小是其独立危险因素。

结论

对于10 mm~20 mm非转移性直肠神经内分泌肿瘤，肿瘤浸润深度和肿瘤大小是组织完整切除的独立危险因素。

关键词: 直肠, 非转移性, 直肠神经内分泌肿瘤, 完整切除, 因素分析
Objective

To investigate the factors influencing the tissue integrity resection rate of 10 mm~20 mm non-metastatic rectal neuroendocrine tumor.

Methods

The hospital database data of patients with rectal neuroendocrine tumor admitted to Department of General Surgery and Gastroenterology, Suqian Hospital, Xuzhou Medical University from January 2008 to April 2019 were retrospectively analyzed, and the characteristics of factors were summarized, to compare and analyze the influencing factors of tissue integrity between endoscopic submucosal resection and transanal resection, it will be meaningful to conduct multi-factor analysis to find out the independent risk factors.

Results

Of the 24 patients, the median age of diagnosis was 43 years (29 to 58 years) and 62.5% was male. The median distance from the anal border was 6.2 cm (3 cm~15 cm). The median tumor diameter was 11.7 mm (10 mm~20 mm).Tumor invasion was confined to the mucosal layer in 12 patients (50%), and the submucosal layer in 12 patients. The median follow-up time was 37.3 months (range 3.5~113.0). The complete resection rate was 84.62% in 13 patients. The complete resection rate was 54.55% in 11 cases. There were significant differences between the two groups (χ2=2.542, 2.663; P=0.028, 0.046). For the comparison of the integrity of histological resection, the invasion depth, tumor size, G stage and microscopic performance were the risk factors influencing the resection or not by univariate analysis, and the significant univariate analysis showed that tumor invasion depth and tumor size were the independent risk factors.

Conclusion

For 10 mm~20 mm non-metastatic rectal neuroendocrine tumors, the depth of tumor invasion and tumor size are independent risk factors for complete tissue resection.

Key words: Rectal, Non-metastasis, Rectal neuroendocrine tumor, Complete resection, Factor analysis
表1 患者的临床病理资料（例）
因素 结果
年龄（岁） 43（29~58）
性别

男

 15（62.5%）

女

 9（37.5%）
镜下表现

宽基底息肉样

 10

突出性肿块

 14
距肛缘距离（cm） 6.2（3~15）
治疗方法

经肛局部手术

 13

经内镜黏膜下切除

 11
肿瘤大小（mm） 11.7（10~20）
肿瘤分级

G1

 22

G2

 2
侵犯深度

黏膜层

 12

黏膜下层

 12
随访 19（79.17%）
随访时间（月） 37.3（3.5~113.0）
表2 两种治疗方式资料对比
因素 经肛局部手术（n=13） 内镜黏膜下切除（n=11） 检验值 P值
年龄 48.0（30~58） 50.0（29~57） Z=-1.697 0.465
性别 χ2=0.552 0.240

男

 5（38.46%） 10（90.91%）

女

 8（61.54%） 1（9.09%）
镜下表现 χ2=0.443 0.371

宽基底样息肉

 5（38.46%） 5（45.45%）

突出性肿块

 8（61.54%） 6（54.55%）
术前超声 χ2=2.542 0.028

黏膜层

 9 3

黏膜下层

 4 8
距肛门距离 6.7（3~8） 10.1（8~15） Z=-0.891 0.226
肿瘤大小 15.6（10~20） 11.9（10~19） Z=-0.251 0.522
整块切除 11（84.62%） 6（54.55%） χ2=2.663 0.046
不完整切除 2（15.38%） 5（45.45%） χ2=0.954 0.112
术后并发症 χ2=0.104 0.786

出血

 2 1

穿孔

 0 1
分级 χ2=0.087 0.943

G1

 12 10

G2

 1 1
表3 完整切除与否因素对比
因素 完整（n=17） 不完整（n=7） 检验值 P值
术式 χ2=0.914 0.123

经肛局部手术

 11 2

内镜黏膜下切除

 6 5
性别 χ2=0.633 0.789

男

 8 7

女

 9 0
年龄 49（29~58） 50（36~57） Z=-1.573 0.924
侵犯深度 χ2=3.114 0.015

黏膜层

 12 0

黏膜下层

 5 7
分级 χ2=3.016 0.004

G1

 15 7

G2

 2 0
肿瘤大小（mm） χ2=3.221 0.002

＜15

 11 2

≥15

 6 5
距肛门距离 9（3~15） 7（5~10） χ2=0.672 0.486
镜下表现 χ2=1.999 0.037

息肉

 9 1

肿块

 8 6
并发症 χ2=0.108 0.823

出血

 2 1

穿孔

 0 1

无

 15 5
表4 研究对象多因素分析结果
变量 β S.E， Wals df Sig. Exp（β） 95% CI
下限 上限
侵犯深度 2.916 1.377 4.467 1 .036 17.628 1.241 275.600
肿瘤大小 3.627 1.323 7.566 1 .008 39.783 2.719 439.068
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