小切口开腹术中内镜治疗 Peutz-Jeghers 综合征患者小肠息肉——附7例分析

背景: Peutz-Jeghers综合征(PJS)患者的小肠多发息肉可引起出血、肠梗阻、肠套叠、息肉恶变等严重并发症,传统外科手术治疗创伤大、术后并发症多,且多次小肠切除术可致短肠综合征。目前关于小切口开腹术中内镜治疗PJS患者小肠息肉的报道较少。目的: 探讨小切口开腹术中内镜治疗PJS患者小肠多发息肉的疗效和可能优势。方法: 回顾性分析南通市第一人民医院1998年9月～2008年10月7例接受小切口开腹术中内镜治疗的PJS患者的息肉切除情况、手术相关并发症和长期随访结果。结果: 7例PJS患者术中共切除929枚小肠息肉,直径≤10mm 492枚,11～30mm 377枚,≥30mm 60枚,最大者45mm×38mm。术后2例患者分别出现肠功能障碍和少量便血,1例术后1年内腹部偶有隐痛不适,经治疗后均好转,无严重并发症和死亡病例。随访1～8年,无患者出现需考虑外科手术治疗的病情变化。结论: 小切口开腹术中内镜治疗能安全有效地切除小肠多发息肉,可反复治疗而无须切除肠段,对PJS患者具有重要临床应用价值。     

双气囊小肠镜对Peutz-Jeghers综合征患者小肠息肉的治疗价值

目的:探讨双气囊小肠镜(double-balloon enteroscopy,DBE)在Peutz-Jeghers综合征(peutz-jeghers syndrome,PJS)患者小肠多发息肉治疗中的应用价值.方法:应用DBE对临床诊断为PJS的患者进行检查和治疗,主要观察指标包括DBE检查治疗的完成情况、小肠息肉切除的数量、大小以及与DBE检查治疗相关的并发症等.结果: 共对18例患者进行34例次检查及治疗(经口18次,经肛16次),平均检查时间95(65-180) min,所有病例均有小肠多发息肉.共成功切除小肠息肉126枚(直径5-10 mm 16枚,11-30 mm 70枚;直径>30 mm 40枚,最大直径50 mm).发现息肉癌变1例.术后3 d发生慢性小肠穿孔1例(0.79%),腹部隐痛不适2例,无引起血色素下降的出血及其他严重并发症发生.结论:DBE能安全可靠的切除Peutz-Jeghers综合征患者深部小肠息肉,在一定程度上可代替开腹手术治疗,具有重要的临床应用价值.     

Peutz-Jeghers综合征小肠息肉的双气囊小肠镜治疗

双气囊小肠镜作为一种新的检查和治疗设备,使针对全小肠的直视检查和治疗干预成为可能。目的：探讨双气囊小肠镜治疗Peutz—Jeghers综合征（PJS）患者小肠息肉的可行性和安全性。方法：回顾性分析解放军空军总医院2004年4月～2009年5月48例PJS患者的双气囊小肠镜检查／治疗情况。结果：48例PJS患者共接受102例次双气囊小肠镜检查（经肛38例次,经口64例次）,行内镜下小肠息肉圈套切除术90例次,切除小肠息肉876枚,其中直径〉50mm的巨大息肉43枚。内镜检查／治疗前52例次有明显临床症状（不完全性肠梗阻35例次,腹痛和腹部不适11例次,消化道出血6例次）,其中45例次（86．5％）经治疗后症状消失或明显缓解。发生较严重内镜治疗并发症5例,其中小肠穿孔2例,消化道出血3例。结论：双气囊小肠镜能安全、有效地治疗PJS患者的小肠多发息肉,在一定程度上可替代外科手术治疗。     

双气囊内镜对小肠巨大息肉的内镜治疗研究

目的 探讨双气囊内镜治疗小肠巨大息肉的安全性和可行性.方法 回顾性分析解放军空军总医院应用双气囊内镜对小肠巨大息肉进行镜下切除的情况:包括息肉的大小、形状、病理、息肉切除方法及手术并发症等,并对患者的内镜随访情况和外科干预情况进行总结.结果 共检出小肠巨大息肉488枚,成功切除442枚(直径20～30 mm 112枚,31～50 mm 280枚,＞50 mm 50枚;最大者长径达80 mm),术中出血47例(10.6%),术后出血4例(0.9%),并发穿孔2例(0.5%).11例患者因息肉巨大无法镜下摘除转行外科手术治疗.结论 谨慎使用双气囊内镜下息肉切除技术,可安全摘除绝大多数小肠巨大息肉.这项技术不仅节省了医疗费用,还可以有效避免因外科手术引起的术后并发症.     

双气囊内镜对小肠息肉的内镜诊治研究

目的 探讨双气囊内镜(DBE)对小肠息肉镜下治疗的可行性及安全性.方法 回顾分析我院自2003年11月～2009年6月接受DBE检查并检出小肠息肉的所有病例,总结和分析小肠息肉的内镜诊断及治疗情况,并评价其安全性.结果 360例患者,共进行566例次DBE检查及治疗,其中检出小肠息肉患者66例(Peutz-Jeghers综合征患者50例,其他小肠息肉患者16例).66例患者共接受122例次DBE镜下治疗(经口 74次,经肛48次).镜下切除小肠息肉共计1 012枚(直径5～10 mm 95枚、1～30mm 599枚,直径31～50 mm 274枚,直径大于50 mm 44枚).66例患者在DBE检查及治疗前86例次有不同的临床症状(不完全肠梗阻36例、消化道出血32例、腹痛及腹部不适18例),其中78例次(90.7%)经内镜治疗后临床症状均明显缓解或消失,另有8例次因小肠息肉巨大(7例)或发现息肉恶变(2例)转外科手术治疗.发生较严重的并发症共6例次(小肠穿孔3例,术后有3例出现引起血红蛋白水平下降的消化道出血).结论 DBE能安全有效地切除小肠多发息肉,可在一定范围内代替外科手术治疗,为小肠息肉患者提供了一种安全有效的微创治疗方法,具有重要的临床应用价值.     

气囊辅助小肠镜治疗Peutz-Jeghers综合征的临床价值

目的探讨气囊辅助小肠镜治疗Peutz-Jeghers综合征(Peutz-Jeghers syndrome,PJS)患者小肠息肉的临床价值与安全性。方法回顾性分析2006年6月-2014年3月在北京军区总医院就诊并行气囊辅助小肠镜下息肉切除术的28例PJS住院患者的临床资料。结果 28例患者共行气囊辅助小肠镜下息肉切除术44例次,其中经口进镜28例次,经肛进镜16例次。1例小肠息肉呈密切分布,给予腹腔镜联合小肠镜切除息肉。17例患者小肠镜前行术前检查,其中6例行小肠钡餐造影检查,11例行小肠仿真CT检查。术前检查组单次切除息肉数高于未检查组。术后出现并发症3例次(消化道出血1例次,术中穿孔2例次),并发症发生率6.8%。结论气囊辅助小肠镜下切除小肠息肉治疗PJS安全有效。术前检查有助于小肠镜进镜方式的选择。对于息肉密集分布患者,单纯镜下切除困难,可内镜联合腹腔镜治疗,一次大量切除小肠息肉,达到较好的治疗效果。     

黑斑息肉综合征52例内镜与外科治疗

目的探讨黑斑息肉综合征(PJS)的内镜与外科手术治疗方案及随访计划。方法回顾分析我院1980~2003年间收治的52例PJS患者的临床资料。结果小肠息肉的发生率最高,达95%,其次为大肠息肉和胃息肉。大部分息肉为错构瘤性,部分为腺瘤性,恶性肿瘤发生率为13.5%(7/52)。大部分息肉行内镜下切除,不能内镜下切除的息肉行外科手术治疗,部分患者进行术中内镜配合治疗。术后内镜复查,随访时间越长,息肉的再检出率越高(P<0.05)。结论PJS患者胃肠道息肉首选内镜下治疗,其次选择剖腹探查手术治疗和配合手术中的内镜治疗。患者应定期行内镜复查,终生进行随访治疗。     

注水小肠镜下黏膜切除术治疗Peutz-Jeghers综合征息肉的临床应用

目的 探讨注水小肠镜下治疗Peutz-Jeghers综合征(PJS)肠道息肉的有效性及安全性。方法 选取2021年4月至2022年10月空军特色医学中心由一名特定医师完成的小肠镜下治疗PJS息肉的患者为研究对象,将患者分为注水小肠镜组和普通注气小肠镜组,对两组患者年龄、性别、肠道息肉切除情况、术中术后并发症、住院天数及住院费用等进行比较。结果共84例PJS患者纳入分析,注水小肠镜组49例患者,普通注气小肠镜组35例患者。两组患者在年龄、性别、切除息肉情况、住院天数及住院费用方面均没有统计学差异。注水组小肠镜治疗术中及术后总并发症发生率明显低于注气组,差异有统计学意义(0%vs 20%,P=0.001)。结论 注水法小肠镜可降低Peutz-Jeghers综合征肠道息肉治疗并发症的发生,值得临床应用及推广。     

双气囊小肠镜黏膜切除术中小肠穿孔一例

黑斑息肉综合征（PJS）因消化道多发息肉及巨大息肉,导致肠梗阻、肠套叠的发生率显著增加,既往外科手术是其主要治疗方法。随着内镜技术的不断进展,双气囊小肠镜对PJS患者小肠息肉的内镜下切除是安全有效的,可以有效降低开腹手术的需要。而在治疗小肠息肉尤其是巨大息肉的过程中,需警惕穿孔的风险。既往的穿孔多表现为迟发性穿孔,而术中即时穿孔罕有报道。本文报道双气囊小肠镜内镜黏膜切除术中封闭小肠穿孔1例。通过对本例患者引起穿孔的原因的分析,以及正确的术中处理的经验小结,旨在为今后推广小肠疾病的内镜治疗提供借鉴。     

内镜下大肠息肉切除107例临床分析

目的探讨内镜下切除大肠息肉的临床疗效及安全性。方法对我院2009年3月至2013年6月收治并行内镜下切除治疗的107例大肠息肉患者的临床资料进行回顾性分析。结果本组107例患者均顺利完成内镜下息肉切除手术，其中104例为1次手术切除成功，分次手术切除3例；术中发生出血3例，无术中穿孔、术后继发性出血等严重并发症发生；术后经病理证实恶变5枚。结论内镜下切除大肠息肉疗效确切、安全性高。     

Endoscopic resection of Peutz-Jeghers polyps throughout the small intestine at double-balloon enteroscopy without laparotomy

BACKGROUND: Small-bowel enteroscopy with the double-balloon method was developed to improve access to the small intestine. This study evaluated the usefulness of this method for the resection of small-intestinal Peutz-Jeghers polyps. METHODS: Two patients with Peutz-Jeghers syndrome underwent nonsurgical double-balloon enteroscopic resection of polyps throughout the small intestine. OBSERVATIONS: Multiple polyps in the jejunum were successfully resected via the oral route, as were the polyps in the ileum via the anal route. All 18 polyps (10-60 mm in size) were resected without subsequent bleeding or perforation. Histopathologically, 3 large polyps (>30 mm diameter) were hamartomas with adenomatous components. CONCLUSIONS: Double-balloon enteroscopy was safe and useful for the diagnosis and the treatment of Peutz-Jeghers polyps throughout the small intestine. Double-balloon enteroscopic polypectomy might preclude complications of Peutz-Jeghers syndrome, including intussusception, bleeding, and tumorogenesis, thereby obviating the need for multiple laparotomies.     

Peutz-Jeghers syndrome: endoscopic detection and treatment of small bowel polyps by double-balloon enteroscopy

INTRODUCTION: Peutz-Jeghers syndrome (PJS) is characterised by a combination of hamartomatous gastrointestinal polyps and mucocutaneous melanin pigmentation. The polyps occur mainly in the small bowel and can lead to intestinal obstruction, intussusception and bleeding. Until only a few years ago, primary surgical resection and intraoperative endoscopy and polypectomy were the only available means of treating polyps in the mid-small bowel in these patients. With the introduction of double-balloon enteroscopy (DBE), we now have not only an improved diagnostic tool but also a non-surgical treatment option. METHODS: Between March 2003 and September 2006 a total of 16 patients with PJS were examined by DBE and treated endoscopically. The size, number and location of the diagnosed and endoscopically resected small-bowel polyps were documented as were all complications associated with the examination or treatment. RESULTS: A total of 47 DBE-procedures were performed (oral approach 39, anal approach 8). The examinations revealed a total of 178 polyps. 47 polyps were removed by endoscopic polypectomy on the grounds of their size and/or gross appearance. The largest small-bowel polyp resected was 50 mm (min. 15 mm, max. 50 mm). A total of four complications occurred (2 episodes of bleeding with a fall in Hb, 1 perforation, 1 propofol-associated decrease in oxygen saturation). CONCLUSION: DBE is a safe and reliable procedure for the diagnosis of small-bowel polyps in patients with PJS. In addition to macroscopic assessment and biopsy of suspicious areas, it permits the exact localisation as well as preoperative marking of polyps that are primary candidates for surgery. DBE revolutionises the therapeutic options for polyps in the region of the mid-small bowel and limits the indications for primary surgical management.     

Small bowel polyps in Peutz-Jeghers syndrome: management by combined push enteroscopy and intraoperative enteroscopy

BACKGROUND: Polyps occur throughout the GI tract in Peutz-Jeghers syndrome; the major problem in the management of the syndrome lies in the small bowel. METHODS: From January 1979 to January 1998, seven patients with Peutz-Jeghers syndrome underwent surveillance. Between 1979 and 1992 they were managed with upper and lower endoscopy every 2 to 3 years and surgery when intestinal obstruction occurred. From 1993 they also underwent enteroclysis and, on the basis of radiologic findings, push enteroscopy and/or intraoperative enteroscopy. Push enteroscopy was then performed every 2 years in all patients. RESULTS: During the first period, 5 of 7 patients underwent emergency small bowel resection (2 operated twice). The patients were divided into 2 groups based on enteroclysis findings; the first comprised 4 patients with multiple polyps throughout the small bowel, and the second included 3 patients with polyps only in the proximal small bowel. Three of the 4 patients with diffuse polyposis underwent intraoperative enteroscopy during which on average 16 polyps per patient were removed (range 10 to 25 polyps; mean diameter 16 mm, range 3 to 50 mm). The remaining patient with diffuse polyposis had a single 25 mm polyp in the terminal ileum removed by retrograde ileoscopy; the more proximal polyps were removed by push enteroscopy. The patients with diffuse polyposis remained asymptomatic during follow-up (mean 50 months, range 47 to 57 months) and also underwent periodic push enteroscopy (mean 2.25 enteroscopies per patient, range 2 to 3) at which a mean of 8.5 polyps per patient (range 4 to 13 polyps) were removed (mean diameter 7.2 mm, range 3 to 15 mm). The 3 patients of the second group underwent periodic push enteroscopy alone (mean 3 per patient) during which a mean of 11.7 polyps per patient were removed (range 7 to 15 polyps: mean diameter 10.9 mm, range 3 to 40 mm). Enteroclysis was not repeated in these patients, who remained asymptomatic during follow-up (mean 47 months, range 46 to 48 months). CONCLUSIONS: More effective clearance of small bowel polyps via enteroscopy will help reduce the need for emergency surgery with extensive intestinal resection in patients with Peutz-Jeghers syndrome.     

Conservative approach in Peutz-Jeghers syndrome: Single-balloon enteroscopy and small bowel polypectomy

AIM: To assess the usefulness of the balloon assisted enteroscopy in preventing surgical intervention in pa-tients with Peutz-Jeghers syndrome (PJS) having a small bowel large polyps. METHODS: Seven consecutive asymptomatic pts(age 15-38 years) with PJS have been collected; six under-went polypectomy using single balloon enteroscopy(Olympus SIF Q180) with antegrade approach using push and pull technique. SBE system consists of the SIF-Q180 enteroscope, an overtube balloon control unit(OBCU Olympus Balloon Control Unit) and a dispos-able silicone splinting tube with balloon(ST-SB1). All procedures were performed under general anesthesia. Previously all pts received wireless capsule endos-copy(WCE). Prophylactic polypectomy was reservedmainly in pts who had polyps 15 mm in diameter. The balloon is inflated and deflated by a balloon control unit with a safety pressure setting range from-6.0 kPa to +5.4 kPa. Informed consent has been obtained from pts or parents for each procedure.RESULTS: Six pts underwent polypectomy of small bowel polyps; in 5 pts a large polyp 15 mm(range 20-50 mm in diameter) was resected; in 1 patient with WCE negative, SBE was performed for previous surgi-cal resection of gastrointestinal stromal tumors. In 2 pts endoscopic clips were placed due to a polypectomy. No surgical complication have been reported. SBE with resection of small bowel large polyps in PJS pts was useful to avoid gastrointestinal bleeding and emergency laparotomy due to intestinal intussuscep-tions. No gastrointestinal tumors were found in sub-sequent enteroscopic surveillance in all seven pts. In order surveillance, all pts received WCE, upper en-doscopy, ileocolonoscopy every 2 years. No pts had extraintestinal malignant lesions. SBE was performed when WCE was positive for significant polyps( 15 mm).CONCLUSION: The effective of prophylactic polyp-ectomy of small bowel large polyps( 15 mm) could be the first line treatment for conservative approach in management of PJS patients.     

Long-Term Results of Polyp Clearance by Intraoperative Enteroscopy in the Peutz-Jeghers Syndrome

PURPOSE: Enteroscopy during laparotomy for Peutz-Jeghers syndrome was introduced in our unit in 1987. Its aim is to achieve more complete polyp clearance and thereby reduce the number of subsequent laparotomies for small intestinal polyps. METHODS: All patients with Peutz-Jeghers syndrome who had undergone intraoperative enteroscopy since its introduction into our unit in 1987 were identified. The numbers of polyps identified by palpation and transillumination and by enteroscopy were recorded. The timing of, indications for, and findings of all subsequent laparotomies were analyzed and compared with data from our unit before the introduction of intraoperative enteroscopy. RESULTS: Twenty-five patients (14 females) were studied. Enteroscopy identified 350 (median 12, range 0–35) polyps not detected by palpation and transillumination. All impalpable polyps were removed endoscopically by snare or biopsy. The median follow-up was 53 (interquartile range, 13–133) months. Six patients have had an additional laparotomy (1 urgent relaparotomy for small-bowel perforation after endoscopic polypectomy, 4 polypectomies, and 1 adhesion obstruction). No patient has required operative polypectomy within 4 years of polyp clearance by intraoperative enteroscopy, compared with registry data of 4 (17 percent) of 23 patients who had more than 1 laparotomy within 1 year. CONCLUSION: Intraoperative enteroscopy for Peutz-Jeghers syndrome improves polyp clearance without the need for additional enterotomies and may help to reduce the frequency of laparotomies.     

Clinical characteristics of Peutz-Jeghers syndrome in Korean polyposis patients

Peutz-Jeghers syndrome is an autosomal dominant inherited disorder characterized by hamartomatous polyps in the small bowel and mucocutaneous pigmentation. Patients with Peutz-Jeghers syndrome often present as surgical emergencies with complications of the polyps, such as intussusception, bowel obstruction, and bleeding. Recently an increased risk of malignancies has also been reported. This study was initiated to determine the clinical features of Peutz-Jeghers syndrome in Korean patients, with special attention to the development of malignancies. Thirty patients with Peutz-Jeghers syndrome were investigated; their median age was 23.5 years, and symptoms appeared at a median age of 12.5 years. Family history was positive in one-half of cases, and mucocutaneous pigmentation was observed in almost all patients (93%). The jejunoileum was the most frequent site of the polyps, and there were generally 10–100 polyps. Multiple laparotomies were performed in a substantial portion of the patients, due mainly to polyp-induced bowel obstruction, and the surgical interventions were begun at a relatively young age (average 21.4 years). Four cases of small-bowel cancer and one case of breast cancer were detected in probands, at a relatively young age (mean 36 years). Cancers of the small bowel, stomach, colon, breast and cervix were diagnosed in the first relatives of the probands. Close follow-up from an early age should thus be performed in patients with Peutz-Jeghers syndrome as they are at high risk of surgical emergency and development of malignancy. Accepted: 25 November 1999     

Peutz-jeghers syndrome manifesting complete intussusception of the appendix and associated with a focal cancer of the duodenum and a cystadenocarcinoma of the pancreas

The unusual occurrence of an “inside-out” appendix reported here is a case of complete intussusception of the appendix of a 45-year-old woman with Peutz-Jeghers syndrome in whom the diagnosis of intussusception was made preoperatively. At laparotomy, the lead point of intussusceptum was revealed to be a Peutz-Jeghers syndrome polyp of the appendix. There was also a cystic lesion in the pancreas, and subsequent distal pancreatectomy revealed a cystadenocarcinoma of the pancreas. Two jejunal Peutz-Jeghers syndrome polyps and two duodenal Peutz-Jeghers syndrome polyps were foundvia intraoperative endoscopies. The duodenal polyps were endoscopically removed, whereas a jejunal wedge resection was performed for the adjoining jejunal polyps. One of the two duodenal polyps possessed an adenocarcinoma focus. To our knowledge, this is the first report of complete intussusception of the appendix caused by a Peutz-Jeghers syndrome polyp.     

Neoplastic transformation arising in Peutz-Jeghers polyposis

PURPOSE AND METHODS: To clarify the potential for malignancy of Peutz-Jeghers polyposis, we investigated 75 gastrointestinal polyps resected surgically or endoscopically from seven patients with this syndrome. RESULTS: There were 19 polyps in the stomach, 18 in the duodenum, 22 in the small intestine, and 16 in the large intestine, and these were histologically composed of 1 pyogenic granuloma, 1 cancer in adenoma, 2 adenomas, and 71 Peutz-Jeghers polyps. Nine of these Peutz-Jeghers polyps were accompanied by an adenomatous component, and, in addition, two of these showed a cancerous transformation with stalk invasion. A total of 12 neoplastic polyps (16 percent) were found in three relatively young patients (aged 20, 25, and 43 years), all of which were pedunculated and located either in the duodenum or in the jejunum. There was no statistical significance in size between the neoplastic polyps (mean ±SD, 20.1±10.8 mm) and the completely hamartomatous polyps (mean ±SD, 15.8±9.0 mm). Moreover, the configuration of these types of polyps seemed similar. CONCLUSION: Neoplastic transformation is not a rare event, and our results may indicate evidence of a hamartoma-adenoma-carcinoma sequence in Peutz-Jeghers polyposis.