内镜下治疗十二指肠占位性病变的安全性、有效性及临床价值研究*

目的评价内镜下治疗十二指肠占位性病变的安全性、有效性及临床价值。方法回顾性分析2012年12月-2016年12月南京医科大学第二附属医院消化内镜中心59例行内镜下治疗的十二指肠占位性病变患者的临床资料。结果 59例患者接受内镜下黏膜切除术(EMR)和内镜黏膜下剥离术(ESD)治疗,男31例,女28例,年龄17~81(58.2±13.3)岁。病变位于十二指肠球部24例(40.68%),降部35例(59.32%)。病灶直径0.2~5.0(1.4±0.9)cm。病变来源于黏膜层39例(66.10%),包括炎性或增生性息肉18例,绒毛状-管状腺瘤6例,高级别上皮内瘤变5例及其他。来源于黏膜下层的病变者20例(33.90%),包括布氏腺瘤4例,异位胰腺5例,脂肪瘤4例,间质瘤4例,神经内分泌瘤2例,平滑肌瘤1例。术中穿孔5例,术后迟发性出血4例,经术中修补及术后止血治疗,无再发穿孔及出血。2例患者追加外科手术治疗。59例患者均接受了3~30个月的术后随访,随访期间无1例复发。结论内镜下治疗十二指肠占位性病变具有可靠的临床疗效,术后并发症发生率低,患者术后恢复好。该技术安全、有效,值得推广应用。

Safety, efficacy and clinical value of endoscopic treatment for duodenal lesions*

Abstract: Objective To assess the safety, efficacy and the clinical value of endoscopic treatment for duodenal lesions. Methods 59 patients with duodenal lesions were treated by endoscope from December 2012 to December 2016. The clinical data were retrospectively analyzed. Results There were 31 male and 28 female patients, aged 17 ~ 81 (58.2 ± 13.3) years. The lesion location included the duodenal bulb (n = 24, 40.68%) and the descending part (n = 21, 25.42%). The diameter of the lesions ranged from 0.2 to 5.0 (1.4 ± 0.9). Thirty-nine (66.10%) lesions originated from the mucosa, including inflammatory/hyperplastic polyps (n = 18, 30.51%), villous/tubular adenoma (n = 6, 10.17%). Twenty (33.90%) lesions originated from the submucosa, including Brunner’s glands adenoma (n = 4, 6.78%), ectopic pancreas (n = 5, 8.47%), lipoma (n = 4, 6.78%). There were 4 delayed bleeding, 5 intraoperative perforation. Two patients received extended surgical resection later, and all the 59 patients showed no recurrence during the followed up (range, 3 ~ 30 months) using endoscopy. Conclusion Endoscopic treatment is a safe, effective, valuable method for the management of duodenal lesions.