内镜下黏膜切除术治疗Peutz-Jeghers巨大十二指肠息肉71例临床研究

Clinical study of giant duodenal polyps managed by endoscopic mucosal resection in 71 cases of Peutz-Jeghers syndrome

目的评估内镜下黏膜切除术(EMR)治疗Peutz-Jeghers综合征(PJS)巨大十二指肠息肉的安全性及有效性。方法收集2013年2月至2020年8月在空军特色医学中心确诊为PJS十二指肠息肉并经EMR治疗的病例资料,统计EMR治疗PJS十二指肠巨大息肉的完整切除率、并发症发生率。比较巨大息肉组(直径≥3 cm)与普通息肉组(直径<3 cm)患者EMR手术完整切除率和并发症发生情况,并分析EMR治疗PJS十二指肠息肉手术并发症发生的影响因素。结果共71例患者纳入研究,男44例,女27例,中位年龄为26岁(5~58岁)。内镜下切除息肉最大中位直径为2.0 cm(0.6~13.0 cm),所有患者均成功实施EMR手术,63例患者EMR治疗PJS十二指肠息肉实现完整切除(63/71,88.7%),巨大息肉组EMR手术完整切除率低于普通息肉组(77.4%比97.5%),差异有统计学意义(P=0.023)。EMR手术相关并发症总发生率5.6%(4/71),1例患者同时存在术中创面渗血和术后胰腺炎。巨大息肉组与普通息肉组间并发症发生率(9.7%比2.5%)差异无统计学意义(P>0.05)。内镜下EMR切除十二指肠息肉有无并发症发生在患者性别、年龄、有无PJS家族史、手术史、息肉数量、切除方式上的差异均无统计学意义(P值均>0.05),而息肉位于乳头部位者并发症发生率(50%,3/6)显著高于非乳头部位者(1.5%,1/65),差异有统计学意义(P=0.001)。结论EMR治疗PJS巨大十二指肠息肉总体安全有效的,可作为PJS十二指肠息肉的首选治疗方案。息肉部位是EMR手术相关并发症发生的重要影响因素。

Objective To evaluate the effificacy and safety of endoscopic mucosal resection(EMR)for giant duodenal polyps in Peutz-Jeghers syndrome(PJS).Methods The clinical data of patients identified as PJS with duodenal polyps were collected at the Air Force Medical Center from February 2013 to August 2020.The complete resection rate and complication rate of EMR in PJS with duodenal giant polyps were analyzed.The complete resection rate and complications of EMR were compared between giant polyp group(diameter≥3 cm)and common polyp group(diameter<3 cm),and the influencing factors of complications of EMR in PJS with duodenal polyp were analyzed.Results Seventy-one cases(44 male and 27 female)were finally enrolled.The median age was 26 years(5-58 years).Median size of the largest polyp resected was 2.0 cm(0.6-13.0 cm).EMR was successfully performed in all cases.Complete resection was achieved in 63 cases(63/71,88.7%).The complete resection rate in giant polyp group was lower than that in common polyp group(77.4%vs.97.5%),and the difference was statistically significant(P=0.023).The total incidence of complications related to EMR was 5.6%(4/71).One patient had intraoperative bleeding and postoperative pancreatitis.There was no significant difference in the incidence of complications(9.7%vs.2.5%)between giant polyp group and common polyp group(P>0.05).There were no statistically significant differences between cases with and those without complications of EMR in gender,age,PJS family history,surgical history,number of polyps,or resection method(P>0.05).The complication rate of cases with ampullary polyps(50%,3/6)was higher than that of cases with non-ampullary polyps(1.5%,1/65),and the difference was statistically significant(P=0.001).Conclusion EMR is safe and effective in the management of giant duodenal polyps in PJS,which may be used as the first-line treatment for PJS with duodenal polyps.Polyp location is an important factor in the occurrence of complications related to EMR.