内镜黏膜下剥离术在十二指肠隆起性病变中的临床应用

Clinical application of endoscopic submucosal dissection on duodenal prominent lesions

摘要:

摘要：目的??评价内镜黏膜下剥离术（ESD）治疗十二指肠隆起性病变的疗效及安全性。方法?回顾性分析2015年9月－2017年11月在诸暨市人民医院消化内科行ESD治疗的21例十二指肠隆起性病变的临床资料。结果?21例患者在全麻下行十二指肠病变ESD治疗，手术操作均顺利完成。21例患者中，男13例、女8例，平均年龄（47.6±9.5）岁。病变位于十二指肠球部14例，十二指肠降部7例，病灶直径（2.4±0.6）cm。病变来源于黏膜层5例，包括管状腺瘤伴高级别上皮内瘤变4例，绒毛状-管状腺瘤1例。来源于黏膜下层者16例，包括Brunner腺瘤9例，异位胰腺4例，类癌1例，平滑肌瘤1例，脂肪瘤1例。所有患者均顺利完成内镜切除手术，围手术期并发症发生率为9.5%（2/21）。其中，术中穿孔1例，均在镜下给予钛夹及尼龙绳夹闭，无迟发性穿孔及追加手术；术中出血1例，均经内镜下止血后顺利完成操作；无感染及狭窄等并发症发生。患者术后平均住院（6.5±2.3）d，术后中位随访时间3.9～24.7个月，平均14个月，所有患者未见复发。结论?十二指肠ESD操作难度大，手术相关并发症发生率较高，但其病变完整切除率高，术后局部复发少，且患者术后恢复快，生活质量较高。因此，ESD是治疗十二指肠隆起性病变安全有效的方法，具有良好的临床应用价值。

Abstract:

Abstract: Objective?To assess the clinical value of endoscopic submucosal dissection (ESD) for duodenal prominent lesions.?Methods?21 patients with duodenal prominent lesions underwent ESD from September 2015 to November 2017 were retrospectively analyzed.?Results?All the patients received operation, including 13 male and 8 female patients. The mean age was (47.6 ± 9.5) years. There were 14 lesions in duodenal bulb and 7 in descending part. The mean diameter of the lesions was (2.4 ± 0.6) cm. 5 lesions originated from the mucosa, including tubular adenoma with high-grade intraepithelial neoplasia (n = 4) and villous/tubular adenoma (n = 1). 16 lesions originated from the submucosa, including Brunner’s glands adenoma (n = 9), ectopic pancreas (n = 4), carcinoid tumor (n = 1), leiomyoma (n = 1), lipoma (n = 1). All the cases received ESD successfully. The perioperative complication rate was 9.5% (2/21), including intraoperative perforation (n = 1), which were closed by titanium clips and nylon clips, no delayed perforation happened and additional surgery needed, and intraoperative hemorrhage (n = 1), were staunched successfully during the operation. No infection or stenosis happened. The mean hospitalized time was (6.5 ± 2.3) days after operation. No recurrence was found during 14 (3.9 ~ 24.7) months of follow-up.?Conclusion?The operation of ESD in duodenum is difficult, and the incidence of surgery-related complications is relatively high, but the high rata of complete resection, less postoperative local recurrence, faster postoperative recovery, and higher quality of life, which can make the duodenal ESD become effective and safe for treatment of duodenal prominent lesions.