内镜下切除十二指肠非壶腹部病变的临床应用分析

Clinical outcomes of endoscopic resection for treating non-ampullary duodenal lesions

目的回顾性分析内镜下切除十二指肠非壶腹部病变(non-ampullary duodenal lesions,NADLs)的安全性和有效性。方法以在解放军总医院第一医学中心接受内镜下切除NADLs的72例患者为研究对象,对患者的基本资料、手术相关资料和术后随访资料进行回顾性分析。结果 72例患者中,36例行内镜下黏膜切除术、22例行内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)、14例行改良ESD术。整块切除率为83. 3%,R0切除率为79. 2%。其中6例(8. 3%)病变发生穿孔、5例(6. 9%)发生迟发出血。68例(94. 4%)进行了术后随访,其中8例(11. 1%)术后复查时病变局灶复发并再次接受内镜下治疗。结论内镜下治疗NADLs是可行的、有效的。但是由于十二指肠特殊的解剖学特点,其手术并发症发生率高,需要通过有效的预防措施来降低其发生率。

Objective To analyze the efficacy and safety of endoscopic resection for the treatment of non-ampullary duodenal lesions( NADLs) retrospectively. Methods A total of 72 patients diagnosed with NADLs underwent endoscopic resection at the Chinese PLA General Hospital. Data on patient demographics,treatment information and follow-up results were retrospectively analyzed. Results Among 72 patients,36 patients underwent endoscopic mucosal resection( EMR),22 patients underwent endoscopic submucosal dissection( ESD) and 14 patients underwent modified ESD. The rate of en bloc resection and R0 resection were 83. 3% and 79. 2%,respectively. Six patients( 8. 3%) experienced perforation and 5 patients( 6. 9%) experienced delayed bleeding. Follow-up endoscopy were performed for 68 cases( 94. 4%) and local recurrence was detected in 8 cases( 11. 1%), and they all underwent repeated endoscopic intervention. Conclusions Endoscopic resection of NADLs is feasible an effective. However, it is associated with high incidence rate of complications owing to the duodenal anatomical peculiarities. Effective methods for preventing complications are necessary.