内镜下十二指肠大乳头肿瘤切除术16例疗效分析并文献复习

Therapeutic outcomes of endoscopic papillectomy for duodenal papilloma in 16 cases and literature review

目的探讨经十二指肠镜行十二指肠大乳头肿瘤切除术的疗效、安全性。方法选择十二指肠大乳头肿瘤患者16例,其中男性10例,女性6例;年龄32~74岁;平均年龄55.6岁。术前经内镜活组织检查为良性肿瘤,且经胰胆管腔内超声(IDUS)检查证实肿瘤未浸润至胆胰管;在十二指肠镜下行包括肿瘤在内的十二指肠大乳头切除;术后送病理检查,进一步确诊病理性质指导下一步治疗,并对患者定期进行随访。结果所有患者均于十二指肠镜下成功切除肿瘤。术后3例患者出现上消化道大出血,1例经给予内镜下止血联合药物治疗后好转,2例经给予药物治疗后好转;2例术后出现急性胰腺炎,经给予保守治疗后好转。2例因术后病理诊断为恶性而转外科手术治疗;无死亡病例发生。所有患者平均随访12.6个月,2例出现术后复发而转外科手术治疗。结论经十二指肠镜行十二指肠大乳头肿瘤切除术可行,安全、微创、有效。术前应充分完善相关检查,严格掌握手术适应证,警惕术后并发症的发生,及时予以处理。

Objective To explore the efficacy and safety of duodenal endoscopic resection of duodenal papilloma.Methods A total of 16 patients with duodenal papilloma were enrolled,which included 10 males and 6 females,aged 32-74 years old with mean age of 55.6 years old.Before operation,benign tumor was diagnosed by endoscopic biopsy,and intrapancreatic ductal ultrasound(IDUS)confirmed tumor was not infiltrated into bile duct.The resection of duodenum papilloma was performed under duodenoscope.The pathological nature after operation was confirmed to arrange treatment plan and regularly followed up.Results All patients were successfully resected under duodenal microscope.After operation,there were 3 patients with massive upper gastrointestinal bleeding,one of them improved after endoscopic hemostasis combined with medication,and other two patients improved after medication.Two patients developed acute pancreatitis after operation and improved after conservative treatment.Two patients were converted to operation treatment because of postoperative pathological diagnosis of malignancy.There was no deadth case.All patients were followed up with mean of 12.6-month,and 2 patients were occurred recurrence and performed operation.Conclusion It is demonstrated that duodenal papilloma resection by duodenoscope is safe,minimally invasive and effective.Before operation,the comprehensive examination should be performed and strictly controlled the operation indications,and pay attention to postoperative complications and deal with them in time after operation.