内镜辅助下十二指肠肿瘤局部切除45例  

Endoscopically-assisted local resection of duodenal tumors:a report of 45 cases

作　　者：邓胜和 李晓云[2] 李疆 汤守元[3] 李新明[4] 张剑[2] 廖晓锋[2] 曹英豪 古俊楠 王继亮[1] 陶凯雄[1] 王国斌[1] 蔡开琳 DENG Shenghe;LI Xiaoyun;LI Jiang(Department of Gastrointestinal Surgery,Union Hospital,TongJi Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院胃肠外科,武汉430022 [2]湖北省襄阳市中心医院普外科 [3]湖北省黄石市中心医院中心院区普外科 [4]湖北省黄石市中心医院普爱院区普外科

出　　处：《临床外科杂志》2019年第10期870-872,共3页Journal of Clinical Surgery

摘　　要：目的探讨内镜辅助下十二指肠肿瘤局部切除的可行性和安全性。方法内镜辅助下十二指肠肿瘤局部切除病例45例,均为湖北省内镜外科协作组2015年1月1日~2018年12月31日收集的病例,统计计划局部切除病例的最终治疗方式以及并发症情况。结果45例病人中,9例肿瘤位于球部,26例位于十二指肠降部,4例肿瘤位于水平部,6例肿瘤位于空肠起始端。45例病人术前评估可行局部切除的病例全部完成病灶局部完整切除,17例开腹行十二指肠局部切除术,3例于机器人辅助下行十二指肠局部切除术,14例于腹腔镜下行十二指肠局部切除术,6例完全内镜下切除,内镜切除腹腔镜修补双镜联合手术5例。严重并发症2例,均为降部肿瘤,1例降部中下段肿瘤术后发生吻合口漏、腹腔出血、切口三级愈合,经两次手术治疗后康复出院;1例降部中上段肿瘤术后出现胰腺创面出血,缝扎止血。结论在内镜技术支持下,十二指肠肿瘤行局部切除可以采用多种手术方式,难以简单通过肿块大小或部位而限定局部切除的可行性标准。Objective To investigate the success rate and safety of endoscopically-assisted local resection of duodenal tumors,and to provide basic background parameters for clinical studies.Methods Cases of endoscopically-assisted local resection of duodenal tumors were collected from the hubei cooperation group of endoscopic surgery that could perform routine intraoperative endoscopic examination and treatment for duodenal tumors from January 1,2015 to December 31,2018.Final treatment of planned local excision cases and complications were counted.Results A total of 45 cases,9 cases had been founded the tumor location in the duodenal bulbar,26 cases the tumor location in the descending part of duodenum,4 cases in the horizontal part of duodenum,6 cases in the end of the duodenal or start segment of jejunum.Complete resection of the lesion was completed in all the 45 cases for local resection.17 cases performed by exploratory laparotomy,3 cases performed by robotic assisted the duodenal partial resection,14 cases performed by laparoscopic duodenal partial resection,6cases performed by complete endoscopic resection and 5 cases performed by endoscopic resection combined withlaparoscopic repaired.2 cases of postoperative complications were all occurred in the descending part of the duodenum.A case tumor of the middle and lower descending duodenum occurred anastomotic leakage,abdominal bleeding and incision infection after surgery.After two operations,he was discharged from hospital.Another case tumor of upper and middle descending duodenum occurred pancreatic wound bleeding,and hemostasis was stopped by suture.Conclusions With the support of endoscopic technology,local resection of duodenal tumors can be performed in a variety of surgical methods,and it is difficult to define the feasibility standard of local resection simply by the size or location of the tumor.

关 键 词：十二指肠 肿瘤 局部切除 胰十二指肠切除术 

分 类 号：R73[医药卫生—肿瘤]