经内镜十二指肠乳头病变切除术的治疗价值研究  

Therapeutic value of endoscopic papillectomy for duodenal papilla lesion

作　　者：王伟[1] 郝璐[1] 施新岗[1] 李兆中[1] 

机构地区：[1]第二军医大学长海医院消化内科,上海200433

出　　处：《中华消化内镜杂志》2017年第7期480-484,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨十二指肠乳头内镜下切除术（EP）治疗十二指肠乳头病变的治疗价值。方法系统回顾2007年6月至2015年12月行EP治疗患者的临床资料，分析EP患者的临床特点、EP技术特征、EP并发症及处理措施、术后复发情况。结果本研究共纳入接受EP治疗的十二指肠乳头病变患者43例。病灶平均直径（22．8±1．2）mm，其中整块切除32例（69．8％），分片切除11例（25．6％）。术后3例（7．0％）患者复发，5例（11．6％）发生延迟出血，4例（9．3％）发生术后胰腺炎，6例（14．0％）出现远期胆管狭窄。术中胰管支架置入是术后胰腺炎的独立保护因素（OR=0．000，95％CI：0．000～）。胰管扩张（OR=13．500，95％CI：1．400—130．191）是术后胆管狭窄的独立危险因素。结论EP是一种创伤小、恢复快、疗效确切、费用较低的微创术式，已逐渐成为十二指肠乳头病变治疗的有效手段。Objective To investigate the therapeutic value of endoscopic papillectomy （EP） for duodenal papilla lesion. Methods Patients with duodenal papilla lesion treated with EP from June 2007 to December 2015 were enrolled. The clinical characteristics, EP technical features, complications, the treatment, postoperative recurrence were analyzed. Results A total of 43 patients were enrolled. The mean diameter of the lesion was 22. 8±1.2 mm. Thirty-two patients （ 69.8% ） received en bloc resection, and 11 （ 25.6% ） received endoscopic piecemeal mucosal resection （EPMR）. After the operation, duodenal papilla lesions recurred in 3 patients （7.0%）, 5 patients （11.6%） had delayed bleeding, 4 （9. 3%） had postoperative pancreatitis, 6 （ 14. 0%） had long-term bile duct stricture. Intraoperative pancreatic stenting （OR = 0. 000, 95% CI： 0. 000-） was the independent protective factor for postoperative pancreatitis. Pancreatic duct dilation （ OR = 13. 500, 95% CI： 1. 400-130. 191 ） was the independent risk factor for postoperative bile duct stenosis. Conclusion EP is minimally invasive with rapid recovery and less cost, and could be recommended for duodenal papilla lesions.

关 键 词：十二指肠疾病 括约肌切开术 内窥镜 手术后并发症 危险因素 

分 类 号：R656.64[医药卫生—外科学]