十二指肠乳头癌前病变的诊断与治疗分析

Diagnosis and treatment of precancerous lesions of duodenal papillary carcinoma

目的提高对十二指肠乳头癌前病变的认识,探讨内镜下乳头切除术(endoscopic papillectomy,EP)治疗的安全性及预后情况。方法回顾性分析经病理确诊的47例十二指肠乳头恶性肿瘤、癌前病变及良性肿瘤患者的完整临床资料,比较三组临床资料。同时,筛选行EP治疗十二指肠乳头癌前病变患者,观察术后并发症、复发率等指标。结果十二指肠乳头癌前病变以腹痛(46.7%)为主要临床表现。总胆红素、直接胆红素、间接胆红素及碱性磷酸酶在三组间差异有统计学意义(P<0.05),但谷丙转氨酶、谷草转氨酶、谷氨酰转肽酶、CEA及CA199在三组之间比较,差异无统计学意义(P>0.05)。MRCP发现乳头占位等阳性率最高(46.2%),其次为CT(25.0%),最低为超声(0)。癌前病变患者内镜下可见乳头充血水肿、结节性改变,质软。EP治疗十二指肠乳头癌前病变,其术后并发症少、复发率明显降低。结论结合临床表现、实验室检查、影像学检查、内镜下表现的分析,对十二指肠乳头癌前病变的诊断具有重要意义,EP治疗十二指肠乳头癌前病变,其安全性高、并发症少、复发率低。

Objective To improve the understanding of the precancerous lesions of duodenal papillary carcinoma and to explore the safety and prognosis of endoscopic papillectomy（ EP）. Methods Complete clinical data of 47 cases of malignant tumor of duodenal papilla,precancerous lesions and benign tumor patients diagnosed by pathology were analyzed retrospectively. At the same time,the patients with precancerous lesions of duodenal papillary carcinoma were screened by EP,and the postoperative complications,recurrence rate and other indicators were observed. Results The precancerous lesions of duodenal papillary carcinoma were mainly characterized by abdominal pain was（ 46. 7%）.TBIL,DBIL,IBIL and ALP in three groups were statistically significant（ P〈0. 05）,but ALT,AST,GGT,CEA and CA199 in three groups were not statistically significant（ P〈0. 05）. MRCP found the highest positive rate was（ 46. 2%）,followed by CT（ 25. 0%） and ultrasound（ 0）. EP was used to treat the precancerous lesion of duodenal papillary carcinoma,and its postoperative complications and recurrence rate were obviously low. Conclusion Combined with clinical manifestation,laboratory examination,imaging examination and endoscopic performance is important for early diagnosis of precancerous lesions of duodenal papilla,and EP is used to treat the precancerous lesions of duodenal papillary carcinoma with high safety,low complication rate and low recurrence rate.