内镜切除术对十二指肠占位性病变的价值研究  

Value of endoscopic resection on duodenal space-occupying lesions

作　　者：吴琼[1] 卢忠生[2] 令狐恩强[2] 李闻[2] 黄启阳[2] 王向东[2] 杜红[2] 朱静[2] 王红斌[2] 孟江云[2] 杨云生[2] 

机构地区：[1]清华大学医学中心,北京100084 [2]中国人民解放军总医院消化内科

出　　处：《中华消化内镜杂志》2017年第6期423-426,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的评价内镜黏膜切除术（EMR）和内镜黏膜下剥离术（ESD）治疗十二指肠病变的疗效及安全性。方法回顾性分析2010年1月至2015年12月在中国人民解放军总医院消化内科应用EMR、ESD治疗的12例十二指肠占位性病变的临床资料。结果12例患者于咽部局麻或全麻下行十二指肠病变EMR或ESO治疗，手术操作均顺利完成。12例患者中男9例、女3例，平均年龄50．0岁（33．0-62．0岁）。病变位于十二指肠球部8例、十二指肠降部4例。病灶直径1．2cm（0．5-3．0cm）；病变来源于黏膜层3例，包括高级别上皮内瘤变2例、绒毛状一管状腺瘤1例。来源于黏膜下层者9例，包括神经内分泌肿瘤3例、间质瘤1例、平滑肌瘤1例、脂肪瘤1例、Brunner腺瘤1例、异位胰腺1例、慢性炎症1例。术后穿孔发生率为8．3％（1／12），经内科保守治愈。术中出血较少，均经镜下止血后顺利完成操作。无感染及狭窄等并发症发生。患者术后平均住院天数6．0d（1．0-12．0d）；平均随访时间23．8个月（3．0-73．0个月），所有患者未见复发。结论EMR及ESD是治疗十二指肠占位性病变安全、有效的方法，具有良好的临床应用价值。Objective To assess the clinical value and safety of endoscopic mucosal resection （EMR） and endoscopic submucosal dissection （ESD） for duodenal lesions. Methods The data of 12 patients with duodenal space-occupying lesions underwent EMR or ESD from January 2010 to December 2015 in Chinese PLA General Hospital were retrospectively analysed. Results All patients received operation, including 9 male and 3 female with mean age of 50. 0 years （ 33.0-62. 0 years）. There were 8 lesions in duodenal bulb and 4 in descending part.The mean diameter of the lesions was 1.2 cm （0. 5-3.0 era）. Three lesions were originated from mucosa, of which 2 were high-grade intraepithelial neoplasia and 1 was villous/ tubular adenoma. Nine lesions were located in submucosa, including 3 cases of neuroendocrine neoplasm, 1 case of stromal tumor, 1 liomyoma case, 1 lipoma case, 1 case of Brunner glands adenoma, 1 case of eetopic pancreas, and 1 inflammatory lesion. One patient had perforation with rate of 8.3% （1/12） and was recovered after conserved treatment. The bleeding was very little during operation. No infection or stenosis happened. The mean hospitalized time was 6. 0 days （ 1.0-12. 0 days） after operation. No recurrence was found during 23.8 months （3.0-73.0 months） of follow-up. Conclusion EMR and ESD are effective and safe for treatment of duodenal space-occupying lesions.

关 键 词：内镜治疗 内镜黏膜切除术 内镜黏膜下剥离术 十二指肠病变 

分 类 号：R735.31[医药卫生—肿瘤]