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

Endoscopic Excision during Minilaparotomy for Small Bowel Polyps in Patients with Peutz-Jeghers Syndrome:Analysis of 7 Cases

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≤10 mm 492枚,11～30 mm 377枚,≥30 mm 60枚,最大者45 mm×38 mm.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.

Multiple small bowel polyps in patients with Peutz-Jeghers syndrome （PJS） may cause severe complications including bleeding, intestinal obstruction, intussusception, and malignant transformation. Conventional surgery has much operational trauma and significant postoperative complications, and repeated small bowel resections may eventually result in short-bowel syndrome. Reports concerning endoscopic excision during minilaparotomy for treating small bowel polyps in PJS patients are quite scarce. Aims： To assess the efficacy and potential superiority of endoscopic excision during minilaparotomy for treating multiple small bowel polyps in PJS patients. Methods： A retrospective analysis was performed in 7 PJS patients undergone endoscopic excision during minilaparotomy from Sep. 1998 to Oct. 2008 in the First People＇ s Hospital of Nantong, Jiangsu Province. The number and size of endoscopically resected polyps, the complications associated with the procedure, and the results of long-term follow-up were analyzed. Results： A total of 929 small bowel polyps was resected in 7 PJS patients, 492 ≤10 mm, 377 ranged from 11-30 mm, and 60 ≥30 mm in diameter, the largest one was 45 mm×38 mm. Post-procedural complications occurred in two patients, including one intestinal dysfunction and one small amount bloody stool; one patient suffered from abdominal pain occasionally one year after the minilaparotomy, all improved after being treated. No other severe complications and fatality occurred. During the 1-8 years follow-up, no severe sequences requiring surgical intervention were observed. Conclusions： Endoscopic excision during minilaparotomy is a safe and effective procedure for the treatment of multiple small bowel polyps. It can be performed repeatedly without the need of small bowel resection, and is valuable for treating PJS patients.