诊断学理论与实践

诊断学理论与实践 ›› 2025, Vol. 24 ›› Issue (04): 401-406.doi: 10.16150/j.1671-2870.2025.04.006

• 指南解读 • 上一篇    下一篇

《中国抗癌协会神经内分泌肿瘤诊治指南（2025年版）》更新精要：消化内镜诊疗解析

计蓓1,2, 苏薇1,2, 庹必光1,2, 刘雪梅1,2()   

  1. 1.遵义医科大学附属医院消化病医院，遵义 563000
    2.遵义医科大学附属医院消化内科，遵义 563000
  • 收稿日期:2025-05-12 修回日期:2025-07-09 接受日期:2025-08-06 出版日期:2025-08-25 发布日期:2025-09-09
  • 通讯作者: 刘雪梅 E-mail：onlyoneliuxuemei@163.com
  • 基金资助:
    国家自然科学基金(82470540);国家自然科学基金(32460215);贵州省科技计划项目(黔科合平台人才HZJD[2021]001);贵州省科技计划项目(黔科合基础-ZK[2023]重点059);贵州省科技计划项目(黔科合平台人才CXTD[2023]001);贵州省科技计划项目(黔科合基础‐ZK［2022］一般659);贵州省高层次创新型人才“百层次人才”计划(黔科合平台人才-GCC[2023]043)

Key updates of China Anti-Cancer Association Guidelines for Diagnosis and Treatment of Neuroendocrine Neoplasms （2025 Edition）： Analysis of gastrointestinal endoscopic diagnosis and treatment

JI Bei1,2, SU Wei1,2, TUO Biguang1,2, LIU Xuemei1,2()   

  1. 1. Digestive Hospital, Affiliated Hospital of Zunyi Medical University, Guizhou Zunyi 563000, China
    2. Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Guizhou Zunyi 563000, China
  • Received:2025-05-12 Revised:2025-07-09 Accepted:2025-08-06 Published:2025-08-25 Online:2025-09-09

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摘要：

胃肠胰神经内分泌肿瘤（gastroenteropancreatic neuroendocrine neoplasms， GEP-NENs）是神经内分泌肿瘤（neuroendocrine neoplasms， NENs）的主要类型，其发病率呈逐年上升趋势，且在不同地区和人群中的分布存在差异。2025年新版《神经内分泌肿瘤诊治指南》为胃肠NENs（gastrointestinal NENs， GI-NENs）的内镜诊疗提供了新的指导。新版指南基于肿瘤大小、病理分级和解剖部位的综合分层标准，内镜黏膜下剥离术（endoscopic submucosal dissection， ESD）/内镜黏膜切除术（endoscopic mucosal resection， EMR）仅推荐用于病灶直径≤10 mm、黏膜/黏膜下层未侵及肌层、无转移的G1级肿瘤；对于≤15 mm且Ki-67<10%的G2级病例，仅限于手术不能耐受者，谨慎选择内镜干预。消化内镜凭借其可视化靶向活检与微创干预的双重特性，在GI-NENs的诊断和治疗中发挥着重要作用。内镜治疗并非单纯技术操作，而是需基于肿瘤分期、分级、全身功能评估及分子特征的综合决策。只有通过多学科协作，实现内镜精准评估、影像学检查与全身治疗的深度整合，构建全程管理体系，积累循证医学证据，才能突破异质性限制，推动NENs诊疗向精准化、个体化发展。

关键词: 神经内分泌肿瘤, 指南, 内镜, 诊断, 治疗

Abstract:

Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are the main type of neuroendocrine neoplasms (NENs). Their incidence rate has been increasing year by year, with variations in distribution across different regions and populations. The 2025 edition of the "Guidelines for Diagnosis and Treatment of Neuroendocrine Neoplasms" provides new guidance on endoscopic diagnosis and treatment of gastrointestinal NENs (GI-NENs). Based on comprehensive stratification criteria incorporating tumor size, pathological grading, and anatomical location, endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are recommended exclusively for G1 tumors with lesions ≤ 10 mm in diameter, confined to the mucosa / submucosa without muscularis layer invasion or metastasis. For G2 neoplasms with lesions ≤ 15 mm and Ki-67 < 10%, endoscopic intervention should be cautiously considered only for patients who cannot tolerate surgery. Digestive endoscopy, with its dual capabilities of visualized targeted biopsy and minimally invasive intervention, plays an important role in the diagnosis and treatment of GI-NENs. Endoscopic therapy is not simply a technical procedure, but requires a comprehensive decision-making process based on tumor staging, grading, systemic function evaluation, and molecular characteristics. Only through multidisciplinary collaboration, the in-depth integration of endoscopic precision evaluation, imaging examination, and systemic therapy, the construction of a whole-process management system, and the accumulation of evidence-based medical data can the limitations of heterogeneity be overcome and the diagnosis and treatment of NENs be advanced toward precision and personalization.

Key words: Neuroendocrine neoplasms, Guidelines, Endoscopy, Diagnosis, Treatment

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