CAJ | 학술논문

目的：探讨胃肠道神经内分泌肿瘤（neuroendocrine neoplasms，NEN）的内镜下表现及治疗方法。方法对2011年5月至2014年12月在北京军区总医院消化内镜中心经内镜和病理确诊的72例胃肠道 NEN 患者进行回顾性分析，分析其内镜下特点及治疗方法。结果72例胃肠道NEN 中以直肠最多见（48例，66.7％），其次为胃（16例，22.2％），十二指肠、食管和回盲瓣也可见。直肠 NEN 在内镜下有一定特征性表现，大多表现为黏膜下肿物；而胃、食管、小肠 NEN 在内镜下表现形式多样，无特定典型表现形式，容易误诊。部分诊断为神经内分泌瘤1级或神经内分泌瘤2级的患者经内镜黏膜下剥离术或内镜与腹腔镜双镜联合治疗，病理诊断为神经内分泌瘤2级或神经内分泌癌的患者，行外科手术切除、静脉化疗或姑息治疗。行内镜下治疗的50例患者均成功完成手术，1例十二指肠球部神经内分泌瘤1级患者在 ESD 术中发生穿孔，无出血发生。随访平均（15.6±13.2）个月，内镜下治疗的患者目前均无局部复发及远处转移。结论胃肠道 NEN 在内镜下表现形式多样，对于部分位于黏膜深层或黏膜下层、直径不超过1 cm 的瘤体可采用内镜手术切除。
목적：탐토위장도신경내분비종류（neuroendocrine neoplasms，NEN）적내경하표현급치료방법。방법대2011년5월지2014년12월재북경군구총의원소화내경중심경내경화병리학진적72례위장도 NEN 환자진행회고성분석，분석기내경하특점급치료방법。결과72례위장도NEN 중이직장최다견（48례，66.7％），기차위위（16례，22.2％），십이지장、식관화회맹판야가견。직장 NEN 재내경하유일정특정성표현，대다표현위점막하종물；이위、식관、소장 NEN 재내경하표현형식다양，무특정전형표현형식，용역오진。부분진단위신경내분비류1급혹신경내분비류2급적환자경내경점막하박리술혹내경여복강경쌍경연합치료，병리진단위신경내분비류2급혹신경내분비암적환자，행외과수술절제、정맥화료혹고식치료。행내경하치료적50례환자균성공완성수술，1례십이지장구부신경내분비류1급환자재 ESD 술중발생천공，무출혈발생。수방평균（15.6±13.2）개월，내경하치료적환자목전균무국부복발급원처전이。결론위장도 NEN 재내경하표현형식다양，대우부분위우점막심층혹점막하층、직경불초과1 cm 적류체가채용내경수술절제。
Objective To investigate the endoscopic findings and treatment of gastrointestinal neu-roendocrine neoplasms.Methods Endoscopic manifestation and treatment were analyzed retrospectively in 72 patients who were diagnosed as having gastrointestinal neuroendocrine neoplasms by endoscopy and pathol-ogy from May 2011 to December 2014.Results In 72 patients of gastrointestinal NEN,rectum was most commonly involved (48 patients,66.7%),followed by the stomach (16 patients,22.2%),duodenum, esophagus and the ileocecal valve.There were certain features in rectal neuroendocrine neoplasms under endoscopy,mostly manifested by submucosal tumors.But gastric,esophageal,and small intestine NEN man-ifestations showed various forms,without specific typical features,and easy to be misdiagnosed.Some patients diagnosed as having NEN G1 or G2 underwent EMR,ESD or laparoscopy combined with endoscopy resection.Patients diagnosed as having NEN G2 or neuroendocrine carcinoma by pathology received surgical resection,chemotherapy or palliative treatment.All 50 patients underwent endoscopic treatment successful-ly.Perforation occurred in one duodenal bulbar G1 patient during ESD.No bleeding occurred during and after the operation.All patients after treatment were followed up for 15.6 +13.2 months on average with no recurrence or metastasis.Conclusion Manifestations of gastrointestinal neuroendocrine neoplasms vary under endoscopy.Some tumors that locate in mucosa or submucosa with diameter less than 1cm can be resec-ted through EMR or ESD.