内镜黏膜下剥离术治疗十二指肠病变的应用

Application research of endoscopic submucosal dissection on duodenal lesions

[目的]研究内镜黏膜下剥离术(ESD)治疗十二指肠病变的疗效及安全性。[方法]回顾性分析应用ESD治疗的44例患者45处十二指肠病变的临床资料。[结果]45处病变均于全麻下行十二指肠病变ESD治疗。45处病变分别位于球部22处(48.9%),降部17处(37.8%),球降交界部位6处(13.3%)。病灶平均直径12.49(11~20)mm。病变来源于黏膜层27例,包括低级别上皮内瘤变9例、增生性息肉6例、黏膜组织慢性炎5例、腺瘤样增生3例、高级别上皮内瘤变2例和管状腺瘤2例;起源于黏膜下层者16例:病理类型分别为神经内分泌肿瘤6例、异位胰腺4例,黏膜下十二指肠腺瘤3例和黏膜下淋巴滤泡增生3例;起源于固有肌层2例,为间质瘤。术中穿孔率22.2%(10/45),其中黏膜下隆起性病变6例、黏膜层病变4例。术后平均住院天数5.4(3~8)d,平均随访时间25.6(3.0~50.0)个月,所有患者未见残留及复发,无感染及狭窄等并发症。[结论]ESD治疗十二指肠病变是安全、有效的,具有良好的临床应用价值。

[Objective]To investigate the efficacy and safety of endoscopic submucosal dissection(ESD)in the treatment of duodenal lesions.[Methods]The clinical data of 50 cases of duodenal lesions treated by ESD in the endoscope center of the Affiliated Hospital of Qingdao University from December 2014 to March 2020 were retrospectively analyzed.[Results]All of the 45 lesions from 44 patients received ESD treatment for duodenal space-occupying lesions under general anesthesia,including 28 males and 16 females,with an average age of 56 years(31.0-75.0 years).There were 22 lesions(48.9%)in duodenal bulb,17 lesions(37.8%)in descending part and 6 lesions(13.3%)in ball-descending junction.The average diameter of the lesion was 12.49 mm(11-20 mm).27 lesions were originated from mucosa,of which 9 were low-grade intraepithelial neoplasia,6 were hyperplastic polyps,5 were chronic mucositis,3 were adenomatous hyperplasia,2 was high-grade intraepithelial neoplasia and 2 was tubular adenoma.16 lesions were originated from submucosa,including 6 cases of neuroendocrine neoplasm,4 cases of ectopic pancreas,3 cases of submucosa duodenal adenoma and 3 cases of submucosa lymphofollicular hyperplasia.2 cases originated from muscularis propria,which were stromal tumors.The intraoperative perforation rate was 22.2%(10/45),including 6 submucosal uplifting lesions and 4 mucosal lesions.The mean hospitalized time was 5.4 d(3-8 d),and the average follow-up time was 25.6 months(3.0-50.0 months).No residual or recurrence was found in all patients,and no complications such as infection and stenosis were found during follow-up time.[Conclusion]ESD is safe and effective in the treatment of duodenal lesions.