十二指肠球部类癌的内镜切除临床疗效分析

The curative effect of endoscopic resection of duodenal bulb carcinoid

目的探讨十二指肠球部类癌的内镜切除治疗的效果。方法回顾性分析2009年6月至2012年6月经内镜切除治疗且术后病理证实的17例十二指肠球部类癌患者资料，其中男11例、女6例，年龄22～52岁，平均（36．3±8．4）岁。结果17例患者术前均应用超声内镜诊断，其中考虑为异位胰腺4例，类癌13例，最大直径0．4～1．0cm，均与固有肌层分界清晰。内镜治疗均取得成功，采用透明帽辅助切除法，术中与术后无并发症出现。术后病理及免疫组化染色均证实为类癌，因此超声内镜的术前诊断准确率为76．5％。患者平均随访观察（20．5±12．4）个月，无复发和转移病例。结论超声内镜可以有效地判定十二指肠球部病变的浸润深度，评价内镜下切除指征，但无法术前定性诊断。内镜透明帽辅助下切除治疗十二指肠类癌是安全有效的。

Objective To assess the curative effect of endoscopic resection for patients with duodenal bulb carcinoid. Methods Data of 17 patients with duodenal bulb submucosal tumor who underwent endoscopic dissection in our department and confirmed as duodenal bulb carcinoid by postoperative pathology from Jun 2009 to Jun 2012 were retrospectively analyzed. Seventeen patients included 11 men and 6 women with the mean age of 36. 3 ~ 8. 4. Results All patients underwent preoperative diagnosis of endoscopic ultrasonography（EUS）. Four cases were diagnosed as heterotopic pancreas and 13 cases carcinoid. The size of tumor was from 4 to 10 millimeter. Cap-assisted endoscopic mucosal resection （EMR-C） were used in all patients successfully. No complications were found during or after the operation. Postoperative pathology confirmed 6 cases of duodenal bulb carcinoid. The accuracy of EUS preoperative diagnosis was 76. 5%. The average follow-up time was 20. 5 ± 12. 4 months. Metastases and recurrence had not been found. Conclusion EUS can confirm the invasive depth of duodenal submucosal tumors and estimate the indication of endoscopic excision. EUS can not give a preoperative qualitative diagnosis of duodenal submucosal tumors. Endoscopic hyaline cap excision is a safe and sufficient method for duodenal bulb carcinoid.