内镜黏膜下剥离术治疗十二指肠非乳头区黏膜下肿瘤的疗效及安全性

Efficacy and safety of endoscopic submucosal dissection for non-papillary duodenal submucosal tumors

目的:探讨内镜黏膜下剥离术(ESD)治疗十二指肠非乳头区黏膜下肿瘤(SMT)的疗效及安全性。方法:回顾性分析2016年1月至2020年12月接受ESD治疗的20例十二指肠非乳头区SMT患者的资料,对病变特点、病理类型、病变切除情况、并发症发生情况及随访结果进行分析。结果:20例中,病变位于十二指肠球部2例,降部16例,球降交界部2例。病变直径1.2~4.8 cm。病变起源于黏膜下层13例,固有肌层7例。术后病理示脂肪瘤5例,Brunner腺瘤4例,胃肠间质瘤4例,平滑肌瘤3例,异位胰腺2例,淋巴管瘤1例,神经内分泌瘤1例。病变整块切除率20/20,完全切除率为19/20。术中穿孔发生率为2/20。术后并发症发生率为1/20,该例发生迟发性穿孔,内镜下缝合及抗感染治疗后好转。术后住院时间为3~12 d。随访16例,随访时间1~42个月,未见复发。结论:ESD对十二指肠非乳头区SMT具有良好的疗效及安全性。

Aim:To investigate the clinical efficacy and safety of endoscopic submucosal dissection(ESD)in the treatment of non-papillary duodenal submucosal tumor(SMT).Methods:A retrospective analysis was performed on the clinical data of twenty patients with non-papillary duodenal SMT who underwent ESD from January 2016 to December 2020.The features and pathological patterns,the resection,complications,and outcomes during postoperative follow-up were assessed.Results:Among the 20 patients,2 lesions were located in duodenal bulb,16 in the descending part,and 2 lesions at the junction of bulb and descending part.The diameter of the lesions was 1.2-4.8 cm.There were 13 lesions originated from submucosal layer and 7 from muscularis propria.Postoperative pathology showed 5 cases of lipomas,4 case of Brunner gland tumor,4 case of gastrointestinal stromal tumor,3 case of leiomyoma,2 case of ectopic pancrea,1 case of neuroendocrine tumor,and 1 case of lymphangioma.The block resection rate was 20/20,complete resection rate was 19/20.The perforationrate was 2/20 during operation.The postoperation complication rate was 1/20.One delayed perforation occured and was cured by endoscopic suture and anti-infective therapy.The postoperative hospital stay was 3-12 days.Sixteen cases were followed up for 1-42 months,and no recurrence was occured.Conclusion:ESD has excellent clinical efficacy and good safety for non-papillary duodenal SMT.