内镜下切除十二指肠乳头部肿瘤的疗效和安全性

目的探讨十二指肠乳头部肿瘤经内镜下切除的有效性和安全性。方法回顾性分析2014年1月至2020年1月于中国医学科学院肿瘤医院内镜科行内镜下十二指肠乳头部肿瘤切除的21例患者的临床病理资料,分析手术效果和术后并发症的发生情况。结果 21例患者均成功行内镜下十二指肠乳头部肿瘤切除,切除病灶大小为0.5~2.8 cm,整块切除19例,分块切除2例。术后总并发症的发生率为52.4%(11/21)。术后迟发性出血8例(38.1%),5例患者通过内镜下止血治疗后出血停止,3例患者经介入栓塞治疗后出血停止;穿孔2例(9.5%),经过抗炎、腹腔穿刺引流等保守治疗后愈合;术后胰腺炎5例(23.8%),给予生长抑素和消炎痛栓肛塞处理后好转。术前活检示,高级别上皮内瘤变11例,低级别上皮内瘤变8例,慢性炎症2例;术后病理结果显示,腺癌4例,腺瘤17例。术前活检病理结果与术后病理的吻合率为38.1%(8/21),其中术前活检病理低估11例(52.4%),高估2例(9.5%)。切缘阳性4例。所有患者预后良好,随访期内无死亡病例。结论对于早期十二指肠乳头部肿瘤应当采取积极的切除治疗策略,内镜下十二指肠乳头部肿瘤切除术安全、有效,可以作为首选术式。

Efficacy and safety of endoscopic papillectomy of major duodenal papilla neoplasms

Objective To discuss the efficacy and safety of endoscopic papillectomy of major duodenal papilla neoplasms.Methods The clinical-pathological data of 21 patients who were admitted to the Department of Endoscopy,Cancer Hospital,Chinese Academy of Medical Sciences and underwent endoscopic papillectomy of major duodenal papilla neoplasms from January 2014 to January 2020 were retrospectively studied,their postoperative outcomes and complication were also analyzed.Results Tweenty-one patients were successfully performed endoscopic papillectomy of major duodenal papilla neoplasms.The resected lesions varied between 0.5-2.8 cm.Completed lesion was resected in 19 cases and lesion blocks in 2 cases.The incidence of postoperative complication was 52.4%(11/21),including 8 cases of postoperative bleeding(38.1%).Five patients stopped bleeding after endoscopic hemostasis and 3 patients stopped after interventional embolization.Two patients experienced perforation(9.5%)and recovered after conservative treatment including anti-inflammatory treatment and abdominal drainage.Five patients had pancreatitis(23.8%)and recovered after treatment with pre-somatostatin and anti-inflammatory rectal suppository.Preoperative pathological results of 21 patients suggested that 11 were high-grade intraepithelial neoplasia and 8 were low-grade intraepithelial neoplasia,and 2 were chronic inflammation.Postoperative pathological results suggested that 4 were adenocarcinoma,and the rest 17 were adenoma.The coincidence rate of preoperative biopsy results and postoperative pathology was 38.1%(8/21),and underestimate of the pathological stage occurred in 11 patients(52.4%)during the preoperative biopsy,overestimate occurred in two patients(9.5%).Four cases had a positive incisal margin.All patients had good prognoses and no death event occurred during the follow-up period.Conclusions Early-stage major duodenal papilla neoplasms should be treated with aggressive resection.Endoscopic papillectomy of duodenal papilla neoplasms is safe,effective,and can be recommended as the preferred procedure for major duodenal papilla neoplasms.