内镜十二指肠乳头肿瘤切除术临床评价(附36例报告)

Clinical efficacy of endoscopic resection of duodenal papilla tumor:A report of 36 cases

目的总结内镜治疗十二指肠乳头肿瘤的经验,探讨其临床价值及并发症防治策略。方法回顾性分析2010年1月至2017年5月复旦大学附属中山医院内镜中心行内镜十二指肠乳头肿瘤切除术的36例病人临床资料。结果 36例病人共行38例次手术,均顺利完成手术。29例次未夹闭创面手术,其中1例次(3.4%)发生穿孔,5例次(17.2%)出现迟发性出血,3例次(10.3%)发生胰腺炎,2例次(6.9%)发生胆管炎,1例次(3.4%)出现影响胆汁和胰液排出的术后狭窄。9例次行留置胰、胆管支架后夹闭创面手术,未发生出血、穿孔及胰腺炎,其中1例次(11.1%)发生胆囊炎,1例次(11.1%)出现影响胆汁和胰液排出的术后狭窄。随访时间30.5(1.0~85.0)个月,2例病人出现复发,予以内镜下再次切除处理。结论内镜十二指肠乳头肿瘤切除术治疗十二指肠乳头肿瘤可能有效,但术后并发症发生率较高,需重点关注。术后留置胰、胆管支架后夹闭创面可能会降低并发症发生率。

Objective To evaluate therapeutic effect of endoscopy on duodenal papilla tumor, and the prevention and treatment methods of its complications. Methods The clinical data of 36 patients underwent the endoscopic duodenal papilla tumor resection in Zhongshan Hospital of Fudan University from January 2010 to May 2017 were studied retrospectively. Results A total of 36 patients underwent 38 procedures successfully. Among 29 cases without postoperative metallic clips closured, perforation occurred in 1 case （3.4%）, delayed bleeding occurred in 5 cases （17.2%）, postoperative pancreatitis occurred in 3 cases （10.3%）, biliary ducts inflammation occurred in 2 cases （6.9%）, and pancreaticobiliary strictures occurred in 1 case （3.4%）. Among 9 cases of postoperative metallic clips closured, there was no delayed bleeding, perforation, and postoperative pancreatitis; biliary ducts inflammation occurred in 1 case （11.1%）, and pancreaticobiliary strictures occurred in 1 case （11.1%）. After following up 30.5（1.0~85.0）months, there were 2 recurrent patients, and both were treated by endoscopy. Conclusion Endoscopic treatment of duodenal papilla tumor may be effective. The incidence of complication is high, but postoperative clips closured may reduce the complications.