摘要
目的评价内镜黏膜下剥离术（ESD）治疗十二指肠占位性病变的临床价值。方法回顾性分析2006年11月至2010年8月间复旦大学附属中山医院内镜中心行ESD术的78例十二指肠占位性病变患者的临床资料。结果78例患者中男性46例，女性32例，年龄（54±9）岁。病变位于十二指肠球部39例（50％）、球降交界部19例（24．4％）、降部20例（25．8％）；病灶直径（2．1±1．7）cm。病变来源于黏膜层者51例（65．4％），包括炎性或增生性息肉22例，绒毛状．管状腺瘤26例，错构瘤性息肉3例：来源于黏膜下层者25例（32．1％），包括布氏腺瘤15例，异位胰腺3例，类癌3例，脂肪瘤2例，黏液纤维瘤和血管淋巴瘤各1例；来源于固有肌层者2例（2．5％），均为异位胰腺。所有患者均顺利完成内镜切除手术，手术时间（37±41）min。术中出血量（23±15）ml。围手术期并发症发生率为35．9％（28／78）．其中术中穿孑L6例．迟发性穿孔3例，术中出血10例，延迟性出血7例，一过性血淀粉酶增高2例。除1例类癌患者术后病理提示脉管内有肿瘤细胞．加行扩大切除手术外．其余77例患者在ESD手术后3。23个月的内镜随访期间，无一例出现复发。结论ESD治疗十二指肠占位性病变安全、有效．值得推广应用。
Objective To assess the clinical value of endoscopic submucosal dissection （ESD） for duodenal leisions. Methods A total of 78 patients with duodenal leisions were treated with ESD from November 2006 to August 2010. The clinical data were retrospectively analyzed. Results There were 46 male and 14 female patients. The mean age was （54±9） years. The lesion location included the duodenal bulb（n=39, 50%）, the junction of bulb and descending part （n=19, 24.4%）, and the descending part （n=20, 25.8%）. The mean diameter of the lesions was （2.1±1.7） cm. Fifty-one （65.4%） lesions originated from the mucosa, including inflammatory/ hyperplastic polyps （n=22, 28.2%）, villous/tubular adenoma （n=26, 33.3%）, and hamartomas polyps （n=3, 3.8%）. Twenty five （32.1%） lesions originated from the submucosa, including Brunner＇s glands adenoma （n=15, 19.2%）, ectopic pancreas （n=3, 3.8%）, carcinoid tumor （n=3, 3.8%）, lipoma （n=2, 2.6%）, myxoinoma（n=1, 1.3%）, and angio-lymphangioma（n=l, 1.3%）. There were two lesions originated from the muscularis propria （n=2, 2.5%）, and both were ectopic pancreas. All cases received ESD successfully. The mean operative time was （37±41） min and the mean blood loss was （23±15） ml. The perioperative complication rate was 35.9%（28/78）, including intraoperative perforation （n=6）, delayed perforation （n = 3 ）, intraoperative hemorrhage （n = 10 ）, delayed bleeding （n =7 ）, and transient elevation of serum amylase （n=2）. Postoperative patholbgical examination showed vascular invasionwith tumor cells in one patient, who received extended resection later. The remaining 77 patients showed no recurrence during the followed up （rang, 3-23 months） using endoscopy. Conclusion ESD is an effective, safe, minimally invasive method for the management of duodenal lesions.
出处
《中华胃肠外科杂志》
CAS
2012年第7期675-678,共4页
Chinese Journal of Gastrointestinal Surgery
基金
上海市科委重大课题（09Dzl950102,11411950502）
国家自然科学基金（81101566）
上海市卫生局人才基金（XYQ2011017）
关键词
十二指肠病变
内镜黏膜下剥离术
治疗效果
Duodenal lesions
Endoscopic submucosal dissection
Treatment outcomes
