ESD切除十二指肠乳头区域肿瘤的初步探索

Preliminary study on ESD for treatment of tumors of duodenal papilla

背景十二指肠乳头区域肿瘤包括十二指肠乳头腺瘤和黏膜下肿物。由于十二指肠乳头特殊的解剖结构,该区域肿瘤的治疗往往是外科手术或者内镜下EMR切除,而ESD切除该区域肿瘤国际和国内报道很少。目的本研究拟探索ESD切除十二指肠乳头区域肿瘤的安全性和有效性。方法回顾收集整理南方医科大学南方医院2017年以来开展的7例十二指肠乳头区域肿瘤ESD术患者资料,术后均未放置胆胰管支架,分析7例患者的基本情况、手术时间、出血情况、穿孔情况、肿物整块切除率、术后胰腺炎的发生情况、迟发出血、迟发性穿孔情况和术后住院时间等。结果本研究共纳入7例患者(4男,3女),中位年龄56岁,中位手术时间60 min,中位出血量2 mL。7例患者肿物均整块切除,术后病理:高级别上皮内瘤变1例、腺瘤性息肉(中度不典型增生)2例、神经内分泌肿瘤(NET,G1)1例,节细胞性副神经节瘤1例,黏膜下层腺肌病1例,高分化腺癌1例。基底切缘见瘤组织残留1例,其余6例基底切缘阴性;7例水平切缘均阴性。术后发生轻症胰腺炎2例,迟发性出血1例,均经保守治疗后好转。7例患者中位术后住院时间6天,均顺利康复出院。结论初步经验来看,ESD切除十二指肠乳头区域肿瘤安全有效,而且术后不一定需要放置胆胰管支架。

Background Tumors of duodenal papilla include duodenal papillary adenoma and submucosal mass.Due to special anatomic structure of the duodenal papilla,surgical resection or EMR is often used for the treatment of tumors in the region.However,endoscopic submucosal dissection(ESD)for treatment of tumors in this region is rarely reported international and in China.Objective To evaluate the clinical safety and efficacy of ESD for treatment of tumors of duodenal papilla.Methods Clinical data of 7 patients with tumors of duodenal papilla who underwent ESD at Nanfang Hospital of Southern Medical University from 2017 were retrospectively reviewed.No biliary or pancreatic duct stents were placed.The basic information,operation time,bleeding,perforation,en bloc resection rate,occurrence of postoperative pancreatitis,delayed bleeding,delayed perforation and postoperative hospital stay of 7 patients were analyzed.Results 7 patients(4 males and 3 females),with a median age of 56 years were included in this study.The median operation time is 60 minutes,and the median blood loss is 2 mL.There were 7 cases of complete resection.Postoperative pathology showed 1 case of high-grade intraepithelial neoplasia,2 cases of adenomatous polyps(moderate atypical hyperplasia),1 case of neuroendocrine tumor(NET,G1),1 case of ganglionic paraganglioma,1 case of submucosal adenomyosis and 1 case of differentiated adenocarcinoma.Residual tumor tissue was found in 1 case at the basal margin.Basal margin was negative in the other 6 cases.Horizontal margin was all negative in 7 cases.Postoperative mild pancreatitis occurred in 2 cases and delayed bleeding occurred in 1 case,which was all relieved after conservative treatment.No delayed perforation occurred.The median postoperative hospital stay was 6 days.All patients were discharged from the hospital successfully.Conclusion According to the preliminary experience,ESD is a safe and effective method for treatment of tumors of duodenal papilla.It is not necessary to place biliary or pancreatic duct stents after operation.