气囊辅助小肠镜分期治疗波伊茨-耶格综合征小肠息肉165例的安全性和有效性随访研究

Follow-up study on the efficacy and safety of balloon-assisted enteroscopy in the treatment of small intestinal polyps in 165 patients with Peutz-Jeghers syndrome

目的评估气囊辅助小肠镜(BAE)分期随访治疗波伊茨-耶格综合征(PJS)小肠息肉的有效性和安全性。方法收集2005年2月至2019年9月多次就诊于空军特色医学中心并行BAE监测和治疗小肠息肉的PJS患者资料,观察BAE分期随访治疗次数、手术相关并发症及其进行内科保守或外科手术治疗的情况。采用Spearman秩相关分析研究BAE随访治疗次数与每次切除小肠息肉数量和最大径的关系。结果共165例PJS患者入组,男98例,女67例,首次就诊平均年龄为(22.5±9.4)岁。165例PJS患者共进行664例次BAE手术,每例患者接受BAE手术的次数、随访治疗次数分别为(4.0±1.8)次和(2.8±1.1)次,接受2、3、4、5、6、7、8、9、10、11次BAE手术的患者分别有26、52、35、28、12、4、2、2、2、2例,接受2、3、4、5、6、7次BAE分期随访治疗的患者分别有165、76、30、12、4、4例。第1~5次BAE随访治疗期间每例患者内镜下切除小肠息肉数量分别为7.0枚(2.0枚,11.0枚)、4.0枚(2.0枚,10.0枚)、3.0枚(1.0枚,8.5枚)、5.5枚(1.8枚,10.3枚)、3.0枚(2.0枚,6.8枚),切除小肠息肉的最大径分别为4.5 cm(3.0 cm,6.0 cm)、3.0 cm(1.5 cm,4.0 cm)、2.0 cm(1.5 cm,3.0 cm)、3.0 cm(2.5 cm,4.0 cm)、2.5 cm(1.5 cm,4.0 cm)。Spearman秩相关分析显示,BAE随访治疗次数与每次切除小肠息肉的数量和最大径均呈负相关(rs=-0.141,P=0.003;rs=-0.400,P<0.01)。BAE切除小肠息肉的手术相关并发症总发生率为3.2%(21/664),61.9%(13/21)的并发症经内科保守治疗后治愈。随访期间PJS合并肠套叠26例,其中20例(76.9%)经BAE切除小肠息肉治疗后肠套叠消失,共13例患者因肠套叠(6例)或息肉最大径较大堵塞肠腔(7例)行外科手术治疗。结论BAE分期随访治疗PJS小肠息肉安全、有效,可减少PJS小肠息肉数量,缩小息肉最大径,并能预防和治疗小肠息肉相关并发症,有效减少PJS患者行外科手术治疗的次数。

Objective To evaluate the efficacy and safety of balloon-assisted enteroscopy(BAE)in the follow-up treatment of small intestinal polyps in patients with Peutz-Jeghers syndrome(PJS).Methods From February 2005 to September 2019,the clinical data of patients with PJS who visited Air Force Medical Center many times and underwent BAE for small intestinal polyps surveillance and treatment were collected.The number of follow-up treatment times under BAE,operation-related complications and conservative theragy or surgical treatment were observed.Spearman rank correlation analysis was used to analyze the correlation between follow-up treatment times under BAE and the number and maximum diameter of small intestinal polyps.Results A total of 165 PJS patients were enrolled,including 98 males and 67 females,and the mean age of first visit was(22.5±9.4)years.A total of 664 BAE operations were performed in the 165 PJS patients.The number of BAE operations and the number of follow-up treatments for each patient were 4.0±1.8 and 2.8±1.1,respectively.There were 26,52,35,28,12,4,2,2,2 and 2 patients who underwent 2,3,4,5,6,7,8,9,10 and 11 BAE operations,respectively.There were 165,76,30,12,4 and 4 patients who received 2,3,4,5,6 and 7 follow-up treatments,respectively.During the first to the fifth times of BAE follow-up treatment,the numbers of small bowel polyps resected under BAE of each patient were 7.0(2.0,11.0),4.0(2.0,10.0),3.0(1.0,8.5),5.5(1.8,10.3)and 3.0(2.0,6.8),respectively;and the maximum diameters of resected small intestinal polyps were 4.5 cm(3.0 cm,6.0 cm),3.0 cm(1.5 cm,4.0 cm),2.0 cm(1.5 cm,3.0 cm),3.0 cm(2.5 cm,4.0 cm)and 2.5 cm(1.5 cm,4.0)cm,respectively.The results of Spearman rank correlation analysis indicated that the number of follow-up treatment under BAE was negatively correlated with the number and maximum diameter of resected small intestinal polyps(rs=-0.141,P=0.003;rs=-0.400,P<0.01).The total incidence of operation-related complications of small intestinal polyps resection under BAE was 3.2%(21/664),and 61.9%(13/21)of the complications were cured by conservative therapy.During the follow-up period,there were 26 cases of PJS complicated with intestinal intussusception,of which 20 cases(76.9%,20/26)disappeared after BAE resection of small intestinal polyps.A total of 13 patients received surgery for intussusception(6 cases)or large polyps blocking the intestinal lumen(7cases).Conclusions BAE is safe and effective in the follow-up treatment of small intestinal polyps in PJS.It can reduce the number and maximum diameter of small intestinal polyps,prevent and treat the complications related to small intestinal polyps,and effectively reduced surgical treatments.