内镜下治疗十二指肠非壶腹部病变51例回顾性分析

Retrospective analysis of 51 cases of duodenal nonampullary lesions treated by endoscopy

目的分析评估内镜下切除十二指肠非壶腹部病变的疗效。方法回顾性分析2016年8月~2021年5月山东潍坊阳光融和医院内镜中心行内镜下切除治疗的51例十二指肠非壶腹部病变患者的内镜及病理资料。结果51例患者均于静脉麻醉下行内镜下微创治疗,手术操作均顺利完成。51例患者中,男34例、女17例,平均年龄54(14~90)岁。病变位置在十二指肠球部有19例(37%),十二指肠降部20例(39%),球降交界部12例(24%)。病灶平均直径13.3(5~40)mm。病变来源于黏膜层40例,黏膜下层11例。行内镜下黏膜切除术(EMR)者34例,热圈套器切除术(HSP)11例,HSP配合尼龙绳结扎1例,内镜黏膜下剥离术(ESD)4例,内镜全层切除术(EFR)2例,内镜下黏膜分片切除术(EPMR)1例,内镜黏膜下挖除术(ESE)1例。术中出血较少,均于术中顺利止血后完成操作,术后无穿孔、无病变残留,术后迟发出血1例,术后无感染、狭窄等其他并发症。结论内镜下治疗十二指肠非壶腹部占位性病变是安全有效的,应该根据病变特点选择合适手术方式,并且通过各种细节的恰当处理以减少并发症。

Objective To analyze and evaluate the effect of endoscopic resection of duodenal non-ampullary lesions.Methods From August 2016 to May 2021,the endoscopic and pathological data of 51 patients with duodenal non-ampullary lesions who underwent endoscopic resection in our hospital’s endoscopy center were retrospectively analyzed.Results All 51 patients were treated with minimally invasive endoscopy under intravenous anesthesia,and the surgical operations were successfully completed.Among the51 patients,34 were males and 17 were females,with an average age of 54(14~90)years.The lesion location was located in the duodenal bulb in 19 cases(37%),in the descending duodenum in 20 cases(39%),and at the junction of the bulb in 12 cases(24%).The average diameter of the lesion was 13.3(5~40)mm.The lesions originated from the mucosa in 40 cases and the submucosa in 11cases.34 cases underwent endoscopic mucosal resection(EMR),4 cases underwent endoscopic submucosal dissection(ESD),1 case under endoscopic submucosal resection(EPMR),and 11 cases underwent hot snare resection(HSP),Including 1 case with nylon rope ligation;2 cases with endoscopic full-thickness resection(EFR),and 1 case with endoscopic submucosal excision(ESE).There was less bleeding during the operation,and the operation was completed after the bleeding was successfully stopped during the operation.There was no perforation and no residual lesions after the operation.There was 1 case of delayed bleeding after the operation.There was no other complications such as infection and stenosis after the operation.Conclusions Endoscopic treatment of duodenal nonampullary lesions is safe and effective.The appropriate surgical method should be selected according to the characteristics of the disease.And through proper handling of various details to reduce complications.