内镜下黏膜切除术及黏膜剥离术治疗十二指肠非壶腹部病变的临床应用

Endoscopic mucosal resection and submucosal dissection for clinical treatment of non-ampullary duodenal lesions

目的分析内镜分片黏膜切除术(EPMR)和黏膜剥离术(ESD)在治疗十二指肠非壶腹部病变(NADLs)中的安全性及疗效。方法选取2013年1月—2020年12月在河南科技大学第一附属医院内镜中心行手术治疗的78例NADLs患者为研究对象,按照手术方式分为EPMR组(24例)、ESD组(21例)及EPMR+ESD组(33例)。对比分析各组患者临床病例资料。结果3组患者的病变部位、病变起源、病灶大小及病理类型差异均无统计学意义(均P>0.05);手术时间分别为(59.4±4.3)min、(71.8±10.1)min、(34.4±5.8)min,差异有统计学意义(F=264.446,P<0.05);完全切除率分别为87.5%(21/24)、90.5%(19/21)、100.0%(33/33),组间差异无统计学意义(χ^(2)=4.400,P>0.05);EPMR组2例发生围手术期穿孔(8.3%),于内镜下治疗后恢复,ESD组发生术中穿孔3例(14.3%)、出血2例(9.5%),予以内镜下电凝止血;EPMR+ESD组发生围手术期穿孔1例(3.0%),予以钛夹夹闭治疗,3组患者均未发生感染、十二指肠狭窄等其他并发症。3组患者术后住院时间分别为(6.4±0.6)d、(6.4±0.8)d、(6.2±1.2)d,差异无统计学意义(F=0.945,P>0.05);3组患者随访期内均未见复发。结论EPMR、ESD治疗NADLs安全、有效,相较于单一方法,EPMR+ESD具有操作快捷的特点,临床应用前景广泛。

Objective To analyze the safety and efficacy of endoscopic piecemeal mucosal resection(EPMR)and endoscopic submucosal dissection(ESD)in the treatment of non-ampullary duodenal lesions(NADLs).Methods Seventy-eight patients with NADLs who underwent surgical treatment at the Endoscopy Center,the First Affiliated Hospital of Henan University of Science and Technology from January 2013 to December 2020 were selected,and divided into EPMR group(n=24),ESD group(n=21)and EPMR+ESD group(n=33)according to surgical modality.The clinical data of the three groups were analyzed comparatively.Results The differences in lesion site,lesion origin,lesion size and pathological type of NADLs were not statistically significant among the three groups(all P>0.05).The duration of surgery were(59.4±4.3)min,(71.8±10.1)min and(34.4±5.8)min,respectively,with statistically significant differences(F=264.446,P<0.05).The complete resection rates in EPMR,ESD and EPMR+ESD groups were 87.5%(21/24),90.5%(19/21)and 100.0%(33/33),respectively,with no significant differences among the groups(χ^(2)=4.400,P>0.05).In the EPMR group,2 cases(8.3%)of perioperative perforation were treated endoscopically and recovered;while in the ESD group,3 cases(14.3%)of intraoperative perforation and 2 cases(9.5%)of bleeding were treated with bipolar electrocoagulation to stop the bleeding;in the EPMR+ESD group,1 case(3.0%)of perioperative perforation was treated with titanium clips.No infection,duodenal stenosis or other complications occurred in any of the three groups.The average postoperative hospital stay was(6.4±0.6)d,(6.4±0.8)d and(6.2±1.2)d in the three groups,respectively,with no statistically significant difference(F=0.945,P>0.05).No recurrence was observed in any of the three groups during the follow-up.Conclusion Both EPMR and ESD are safe and effective for NADLs,compared to a single method,their combined use for NADLs requires a shorter operative time,which will have a wide clinical application prospect.