内镜黏膜下剥离术及内镜下黏膜切除术治疗十二指肠癌前病变及十二指肠早期癌的临床研究

Clinical study of endoscopic mucosal dissection and endoscopic mucosal resection in treatment of duodenal precancerous lesions and early duodenal carcinoma

摘要:

目的 探索内镜黏膜下剥离术（ESD）及内镜下黏膜切除术（EMR）治疗十二指肠癌前病变及十二指肠早期癌的效果及安全性。方法 回顾性分析2016年9月－2021年3月16例于该院发现并行ESD及EMR治疗的十二指肠癌前病变或十二指肠早期癌患者的临床资料，分析ESD及EMR的临床疗效及安全性。结果 16例患者中，14例病变位于降段乳头对侧或偏对侧，2例病变位于球降交界部，病变大小0.8～2.6 cm，平均（1.2±0.7）cm，切除标本大小1.5～3.5 cm，平均（2.2±0.8）cm，手术时间54～127 min，平均（68.6±25.9）min。9例一次性整块切除病变；7例沿病变外周3 mm环形切开黏膜层及黏膜下层，用圈套器圈套切除，残留组织用碗状热凝钳切除；用止血夹对吻缝合或止血夹联合尼龙绳行荷包缝合创面。术后1例患者行ESD整块剥离后发生术后穿孔，追加腹腔镜下局部修补手术，术后患者恢复良好出院，其余患者均无并发症发生，效果良好。结论 对于十二指肠黏膜的癌前病变及十二指肠早期癌，内镜微创切除治疗是一种重要的治疗方法，疗效确定，术后迟发性穿孔是主要并发症。

Abstract:

Objective To explore the efficacy and safety of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) in treatment of duodenal precancerous lesions and early duodenal carcinoma.Methods A retrospective study was conducted to analyze the clinical data of 16 patients with duodenal precancerous lesion or early stage cancer who were treated with ESD and EMR from September 2016 to March 2021 were collected, and evaluated the clinical efficacy and safety of ESD and EMR treatment.Results Among the 16 patients, 14 cases were located on the opposite or contralateral side of the descending nipple, 2 cases were located at the junction of the descending nipple, the size of the lesion was 0.8 ~ 2.6 cm, with an average of (1.2 ± 0.7) cm, the size of the resected specimen was 1.5 ~ 3.5 cm, with an average of (2.2 ± 0.8) cm, and the operation time was 54 ~ 127 min, with an average of (68.6 ± 25.9) min. 9 cases were excised at one time; In 7 cases, the mucosal layer and submucosal layer were cut along the 3 mm ring of the lesion periphery, and the remaining tissue was excised by a trap, and the residual tissue was excised by a bowl shaped thermocoagulation forceps. Suture the wound with hemostatic clip or purse suture with a hemostatic clip and nylon rope. Postoperative perforation occurred in 1 patient after ESD, and laparoscopic local repair was performed, the patient recovered well after surgery and was discharged from hospital. The other patients had no complications and had good healing recovery.Conclusion Endoscopic minimally invasive resection is an important treatment method for precancerous lesions and early cancers of the duodenal mucosa, with definite efficacy. Postoperative delayed perforation is the main complication.