内镜下切除非壶腹部十二指肠腺瘤的临床价值  

Safety and efficacy of the endoscopic resection of large nonampullary duodenal adenomas

作　　者：孔阳[1] 王拥军[1] 冀明[1] 李鹏[1] 张澍田[1] 

机构地区：[1]北京,首都医科大学附属北京友谊医院消化内科,100050

出　　处：《中华消化内镜杂志》2014年第10期563-566,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨内镜下切除非壶腹部十二指肠腺瘤的安全性及有效性。方法对非壶腹部十二指肠腺瘤（均≥1cm）患者，采用内镜下黏膜切除术，对抬举征阳性者进行一次圈套整块切除或分次圈套切除；回收组织送病理检查。术后进行内镜随访。结果20例中6例（30％）腺瘤位于十二指肠球部，13例（65％）位于十二指肠降部，1例（5％）位于十二指肠水平部。病灶直径平均（1．9±1．1）em，其中1．0～2．0em14例，〉2．0em6例。12例（60％）切除前行超声内镜检查，腺瘤均起源于黏膜层。15例整块切除，5例分块切除，平均操作时间（33．8±16．7）min。术后出血4例，均发生于术后24h内，内镜下止血均成功；无穿孔发生。术后病理检查，均获完整切除，管状腺瘤14例（70％），绒毛管状腺瘤6例（30％）。17例术后随访2—39个月，1例于术后6个月复发，余16例无复发。结论内镜下切除非壶腹部十二指肠腺瘤是安全、有效的。Objective To evaluate the safety and efficacy of the endoscopic resection of large nonampullary duodenal adenomas. Methods Twenty cases with large nonampullary duodenal adenomas（ 1.0 cm） were referred for EMR. After submucosal injection of the mixture of glycerin fructose solution and methylene blue, either en bloc or piecemeal snare polypectomy was performed. All resected specimens were retrieved for pathologic study. Follow-up gastroscopy was performed in patients after EMR. Results Among 20 lesions, six were found located in the 1st part（30% ）, 13 were in the 2nd part（65% ）, and one in the 3rd part（5% ） of the duodenum. The mean diameter of the lesions was 1.9 ± 1.1 cm. Endoscopic ultrasonography （EUS） was performed in 12 patients, and all lesions were originated from the mucosa. EMR was performed successfully in 20 patients. The en bloc resection rate was 75% （ 15/20）, and the mean time for EMR was 33.8 ±16. 7 min. The perioperative complication rate was 20% （4/20）. Bleeding occurred within 24 hours after EMR in 4 cases. There were no perforations. The complete resection rate was 100%. Of these 20 adenomas, 14 adenomas were tubulous and 6 was tubulovillous. During the follow-up period （2-39 months）, 1 patient showed recurrence within 6 months after EMR. Conclusion Endoscopic resection of large nonampullary duodenal adenomas is safe and effective treatment.

关 键 词：腺瘤 十二指肠 肝胰管壶腹 内镜下黏膜切除术 

分 类 号：R735.31[医药卫生—肿瘤]