| Objective: 1.1. Try to explore the clinical pathological characteristics and prognosis of gastrointestinal neuroendocrine neoplasm so as to improve the level of its clinical diagnosis and treatment. 2.To evaluate the effectiveness and the risk factors and complications of ESD treatments for the patients with GI-NENs.Methods: 1.Clinical information of 154 patients with GI-NENs were collected and analyzed in the First Affifiliated Hospital of Nanchang University from Nov.2007 to Apr.2015, To classification and diagnosis by a new method. Adopt the method of retrospective analysis and follow-up, with statistics of onset age, sex, tumor location, clinical manifestations, treatment and pathological results, and follow-up of patients with postoperative survival situation, then based on the statistical analysis of such data. 2. A total of 97 patients with GI-NENs underwent ESD were analyzed. First, incidence rate and clinical course of complications as bleeding or perforation, duration, tumors location and so on were evaluated.Result: 1 The pathological characteristics and prognosis of gastrointestinal neuroend-ocrine neoplasm 1.1 There were 154 patients involved in this study. Of all the patients, 4 cases were in 2007 while 4 in 2008,11 in 2009,6 in 2010,13 in 2011,27 in 2012,36 in 2013,41 in 2014,12 from Jan to Apr in 2015. The number of male and female are 98 and 56, the male-to-femal ratio is 1.75:1. The onset age varied from 20 to 80. 1.2. Lesion location of all the 154 cases,16 are in the stomach while 19 in the duodenum, 4 in the esophagus, 8 in the colon, 1 are in the small bowel, 106 in rectum. 1.3.The main symptoms of these patients included abdominal pain,ventosity, gastrointestinal hemorrhage, diarrhea etc.The most common symptom is abnormal defection that included 41 cases, asymptomatic in 27, gastrointestinal bleeding in 12, stomachache in 25, ventosity in 22, abdominal mass in 3, dysphagia in 6 and so on. 1.4.The lesions of 151 cases are detected by routine gastrointestinal endoscopy, the lesion detection rate of other accessory examinations such as CT, abdominal ultrasonography, EUS were respectively 69.1%, 19% and 100%. 1.5. There are treatment data of 135 cases, including 16 cases of surgical treatment, endoscopic excision in 113 cases, 5 cases underwent surgery after endoscopic excision, 1 case underwent ERCP+ERBD, 1 case access drug treatment, 18 cases refuse treatment. 1.6 The difference of the positive rate of Syn, Cg A, NSE, CK18 were statistically significant while he positive rate of CK8?CK are not. 1.7 Pathological staging information was reported in 152 cases, of which the G1 in 102 cases, G2 in 9 cases, G3 in 41 cases. The positive rate of Syn, Cg A, NSE, CK8, CK18, CK are respectively 92.6%(137/148), 39.7%(58/146), 84%(100/119), 96.2%(75/78), 97.6%(80/82), 91.4%(53/58).The differences in cases with different pathological staging,pathological type about location and distant metastasis. 1.8 We follow up 83 cases, the follow rate was 53.2%, the follow-up time is 7-93 months, the 1-,3-,5-year total survival rates were respectively 95.1%, 90.24%, 89.02%. According to the results of survival analysis, distant metastasis?surgical?pathological grading?pathological type related to the prognosis of patients. Cox multivariable survival analysises showed the adverse prognostic fators were :advanced age, distant metastasis, non-surgery?worse pathological staging?lower location in gastrointestinal tract. 2 The effectiveness and the risk factors and complications of ESD treatments for the patients with GI-NENs. 2.1 This study includes statistics of 97 patients underwent ESD. The number of male and female are 61 and 36, the rate is 1.7:1. The onset age is 20~80. 2.2 Of all the 97 cases,6 of them had lesions in the stomach, 10 in the duodenum, 81 in rectum. Endoscopic checked out 103 lesions, of which 1 case had two lesions in the stomach and 5 cases had two lesions in the rectum. Diameters of the lesions varied from 0.3-2.5cm(mean 0.67cm), while 25 were less than 5cm, 57 in 5-10 cm, 16 in 10-15 cm and 5 greater than 15. 2.3 The duration of operations were 6-66min(mean 20.86min). During the ESD operations,5 patients had few hemorrhages and 2 patients had perforation.3 patients had delayed bleeding. Delayed perforation occurred in 1. 2.4 The difference in cases with bleeding and perforation during the ESD procedure about onset age, sex, loction, pathological grading, pathological type, diameter?surface, metal clip, origin, eco uniformity, eco height were not statistically significant. The bleeding related to operation time, but not a independent risk factor(P=0.118 OR 0.226 95%CI 0.035-1.461).Conclusion 1 GI-NENs could occurred in any part of the gastrointestinal tract. it occurs principally in the rectum, then the stomach?duodenum?esophagus?colon or small bowel.The incidence of it rises year by year, of which men has a higher morbidity than women. The clinical characteristics of GI-NENs is ulcer type,.The endoscopic as a routine examine method. 2 The diagnosis of GI-NENs should be made based on the pathological result.. Pathological grading?pathological type related to location. 3 According to the results of survival analysis, age, distant metastasis, pathological grading, pathological type are related to the prognosis of patients. 4 As a novel procedure for the treatment of upper gastrointestinal neuroendocrine neoplasm, ESD is safe and efficacious in clinic. Postoperative delayed hemorrhages have close realationship with ESD operations about operation time, but not the independent risk factor. |
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