十二指肠Brunner腺瘤的内镜治疗

Endoscopic treatment of duodenal Brunner adenoma

目的探讨十二指肠Brenner腺瘤内镜治疗的价值。方法回顾性分析2006年11月至2011年5月间复旦大学附属中山医院内镜中心行内镜治疗且经病理证实的29例十二指肠Brunner腺瘤患者的临床资料。结果29例患者中男性13例，女性16例，中位年龄为55（29-72）岁。病灶大小（1．7±0．1）cm，其中0．5-1．0cm17例。1．0-2．0cm6例，大于2．0cm6例。无蒂隆起性病灶18例；有蒂病灶11例，其中粗蒂3例，亚蒂2例。内镜治疗中采取圈套电切9例（其中3例外加尼龙绳结扎），内镜黏膜切除术12例，内镜黏膜下剥离术8例，均获完整切除。术中出血1例约200ml，经多枚金属夹夹闭和尼龙绳圈套后成功止血；术中穿孔1例，予金属夹夹闭：术后第2天发生迟发性出血1例，行内镜止血。全组术后随访2。39（中位数13）个月，生活质量较好，未见任何远期并发症。术后1年复发1例。再次予内镜黏膜下剥离术治疗。结论内镜治疗对于Brunner腺瘤是一种安全、有效的治疗方法。

Objective To evaluate the value of endoscopic treatment for duodenal Brunner adenoma. Methods Twenty-nine cases of duodenal Brunner adenoma were diagnosed by pathology between November 2006 and May 2010 in the Endoscopy Center of Zhongshan Hospital. The clinical data were retrospectively analyzed. Results In 29 cases, there were 13 males and 16 females. The median age was 55 （29-72） years. The mean adenoma diameter was （1.7±0.1） cm, among which 17 adenomas ranged from 0.5 to 1.0 cm, 6 ranged from 1.0 to 2.0 cm, and 6 greater than 2.0 cm. Nine cases were treated by polypectomy, 12 by endoscopic mucosal resection （EMR）, and 8 by endoscopic submucosal dissection （ESD）. En-bloc resection rate was 100%. Intraoperative bleeding was seen in one case （200 ml）, managed by nonsurgical method, including electrocoagulation, metal clips and nylon rope. Perforation occurred in 1 case during the procedure and was managed by metal clips. Delayed bleeding occurred in 1 case in the second day and was managed endoscopicaUy. During a median followup of 13 （range, 2-39） months, the quality of life was satisfactory in this cohort, and no patients developed long-term complications. There was one recurrence within 1 year after the procedure and a second ESD was performed. Conclusion Endoscopic treatment is technically feasible and may be considered as the procedure of choice for duodenal Brunner adenoma.