预切开内镜下黏膜切除术与内镜黏膜下剥离术治疗十二指肠非壶腹部病变的疗效及安全性比较

Comparison of the efficacy and safety of pre-cut-endoscopic mucosal resection and endoscopic submucosal dissection for non-ampullary duodenal lesions

摘要:

目的 比较预切开内镜下黏膜切除术（Pre-cut-EMR）与内镜黏膜下剥离术（ESD）治疗十二指肠非壶腹部病变的临床疗效及安全性。方法 回顾性分析2015年6月－2021年6月宁波市医疗中心李惠利医院64例确诊为十二指肠非壶腹部病变的患者的临床资料。其中，30例行Pre-cut-EMR，34例行ESD。比较两组患者病灶特征、手术时间、并发症发生率、整块切除率、R0切除率和术后组织病理学结果。结果 两组患者病灶宏观形态、迟发性出血、整块切除率、R0切除率和术后病理等比较，差异均无统计学意义（P > 0.05）。所有患者均成功完成内镜下切除，整块切除率为100.0%，总体R0切除率为96.9%，术后均未发生迟发性穿孔。Pre-cut-EMR组手术时间为（24.6±6.5）min，明显短于ESD组的（37.5±9.5）min，术中穿孔率为3.3%（1/30），明显低于ESD组的23.5%（8/34），差异均有统计学意义（P < 0.05）。Pre-cut-EMR组病灶直径为1.40（1.30，1.70）cm，小于ESD组的1.45（1.30，2.00）cm，但差异无统计学意义（P > 0.05）；Pre-cut-EMR组病灶直径 ≥ 2.0 cm的比例为10.0%（3/30），低于ESD组的32.4%（11/34），差异有统计学意义（P < 0.05）。结论 Pre-cut-EMR和ESD治疗十二指肠非壶腹部病变的疗效相当，但Pre-cut-EMR手术时间更短，术中穿孔率更低，治疗直径 < 2.0 cm的病灶是安全有效的。

Abstract:

Objective To compare the clinical efficacy and safety of pre-cut-endoscopic mucosal resection (Pre-cut-EMR) and endoscopic submucosal dissection (ESD) for non-ampullary duodenal lesions.Methods Clinical data of 64 patients diagnosed as non-ampullary duodenal lesions in Ningbo Medical Center Lihuili Hospital from June 2015 to June 2021 were retrospectively analyzed. 30 patients underwent Pre-cut-EMR and 34 patients underwent ESD. The lesion characteristics, operation time, complication rate, block resection rate, R0 resection rate and postoperative histopathological results were compared between the two groups.Results There were no significant differences between the two groups in the macroscopic morphology of lesions, delayed bleeding rate, block resection rate, R0 resection rate and postoperative pathology (P > 0.05). Endoscopic resection was successfully completed in all the patients, with the block resection rate of 100.0% and R0 resection rate of 96.9%, and no postoperative delayed perforation occurred. The operation time of the Pre-cut-EMR group was (24.6 ± 6.5) min, which significantly shorter than that of the ESD group (37.5 ± 9.5) min, and the intraoperative perforation rate was 3.3% (1/30), which significantly lower than that of the ESD group 23.5% (8/34), the difference were statistically significant (P < 0.05). The lesions diameter in the Pre-cut-EMR group was 1.40 (1.30, 1.70) cm, smaller than that in the ESD group 1.45 (1.30, 2.00) cm, but the difference was not statistically significant (P > 0.05), while the proportion of Pre-cut-EMR group with lesions diameter ≥ 2.0 cm was 10.0% (3/30), lower than that of ESD group 32.4% (11/34), the difference was statistically significant (P < 0.05).Conclusion The efficacy is comparable between Pre-cut-EMR and ESD for treating non-ampullary duodenal lesions, Pre-cut-EMR has shorter operation time and lower intraoperative perforation rate, Pre-cut-EMR is safe and effective in treating lesions with diameter < 2.0 cm.