内镜下十二指肠乳头切除术对十二指肠乳头部腺瘤的治疗价值

The therapeutic value of endoscopic papillectomy for adenoma in major duodenal papilla

目的评价内镜下十二指肠乳头切除术在十二指肠乳头部腺瘤治疗中的应用价值。方法回顾性分析31例因十二指肠乳头部腺瘤行内镜下十二指肠乳头切除术治疗患者的临床资料，总结内镜治疗完成情况、并发症发生情况以及术后随访情况。结果29例（93．5％，29／31）成功完成内镜下十二指肠乳头切除术治疗，术后病理提示腺瘤伴低级别上皮类瘤变25例、腺瘤伴上皮类瘤变4例。术中1例（3．4％，1／29）发生出血，无穿孔；术后无出血和穿孔，17例（58．6％，17／29）并发高淀粉酶血症、3例（10．3％，3／29）并发轻度胰腺炎，均经内科保守治疗痊愈。有2例（6．9％，2／29）伴有上皮类瘤变者分别在术后6个月及2年后复发；其余27例随访期间无复发，随访时间11个月至5年，平均（33．6±8．5）个月。结论内镜下十二指肠乳头切除术治疗十二指肠乳头部腺瘤安全可行，具有较好的临床应用价值，虽然术后复发率较低，但仍应注意密切随访。

Objective To study the therapeutic value of the endoscopic papillectomy for adenoma in the major duodenal papilla. Methods All 31 cases with the major duodenal papilla undergoing endoscopic papillectomy from January 2008 to June 2013 were retrospectively reviewed. The clinical data, endoscopic treatment, complications and follow-up were analysed. Results Endoscopic papillectomy was performed successfully in 29 patients. Post-operative pathology showed adenoma with low-grade dysplasia in 25 cases and high-grade dysplasia in 4 cases. One patient （ 3.4% , 1/29 ） bled during operation ; and there was no bleeding after operation. There was no perforation during and after the operation. Seventeen patients （58.6%, 17/29） developed hyperamylasemia and 3 patients （ 10. 3%, 3/29） got mild pancreatitis, which were cured by conservative treatment. During follow-up, 2 patients （6. 9% ,2/29 ） with high-grade dysplasia had tumor recurrence after 6 months and 2 years respectively. The 27 other patients had no recurrence during the follow-up period. The shortest follow-up was 11 months, the longest was 5 years, with a mean time of 33.5± 8.5 months. Conclusion Endoscopic papilleetomy is feasible and safe for early tumors of the major duodenal papilla. Although the postoperative recurrence rate is low, it still needs close follow-up.