家族性腺瘤性息肉病合并十二指肠腺瘤的诊疗分析  

Surveillance and management of duodenal adenomas in familial adenomatous polyposis

作　　者：高翔[1] 肖剑春[1] 杨庭楷 谢勇[1] 张冠南[1] 洪涛[1] 曲强[1] Gao Xiang;Xiao Jianchun;Yang Tingkai;Xie Yong;Zhang Guannan;Hong Tao;Qu Qiang(Department of General Surgery,Peking Union Medical College Hospital,Peking Union Medical College&Chinese Academy of Medical Sciences,Beijing,100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院基本外科,北京100730

出　　处：《中华医学杂志》2020年第28期2203-2206,共4页National Medical Journal of China

基　　金：2019年北京市临床重点专科卓越项目。

摘　　要：目的探讨家族性息肉病合并十二指肠腺瘤的临床特点、内镜特征、癌变情况、随访及治疗方法。方法收集北京协和医院45例家族性腺瘤性息肉病患者的临床资料,回顾分析其中合并十二指肠腺瘤患者的临床特点、内镜特征、病理结果、随访及治疗方法。结果15例(33%)患者合并十二指肠腺瘤,年龄(46.8±12.8)岁,较不合并十二指肠腺瘤者平均年长9岁,差异有统计学意义(P<0.001),二者在性别构成上的差异无统计学意义(P=0.904)。内镜随访时间(35.5±22.1)个月,有3例在内镜随访过程中Spigelman分期升级。有5例腺瘤直径>20 mm,其中有4例累及十二指肠乳头。2例诊断为壶腹癌,1例接受了胰十二指肠切除术,1例接受了保留幽门的胰十二指肠切除术,其他需治疗的病例接受了内镜下黏膜切除术。结论十二指肠腺瘤在家族性息肉性腺瘤病患者中比较常见,对于确诊为家族性息肉性腺瘤病的患者,应该常规行严密的上消化道内镜检查。结合Spigelman评分,腺瘤的部位及大小是癌变的高危因素。手术切除和内镜下切除为主要治疗方法。Objective To investigate the clinical manifestations,endoscopic features,potential risk factors for cancerization,surveillance and therapeutics of duodenal adenomas in familial adenomatous polyposis(FAP).Methods Forty-five cases with FAP at Peking Union Medical College Hospital were collected.The clinical data including clinical manifestations,endoscopic features,pathological results,surveillance,and therapies of the 45 patients were retrospectively analyzed.Results Duodenal adenomas was present in 15 patients(33%,8 males),with a mean age of(46.8±12.8)years,which was 9 years older than those without duodenal adenomas(P<0.001).No gender difference was found(P=0.904).The mean endoscopic follow-up time was(35.5±22.1)months.The Spigelman stage increased in 3 patients.The polyp size was greater than 20 mm in 5 patients and duodenal papilla was involved in 4 of them.Two of the 5 patients were diagnosed as ampullary carcinoma.Whipple′s procedure was performed in one of them and pylorus preserving pancreaticoduodenectomy(PPPD)was performed in the other.Endoscopic mucosal resection was performed in the rest of the patients who required intervention.Conclusions Duodenal adenomas are common in FAP.Upper gastrointestinal endoscopy is recommended in patients diagnosed with FAP.Combining with Spigelman scoring system,the location and the size of the polyp are risk factors associated with the development of duodenal carcinoma.

关 键 词：腺瘤息肉病 结肠 十二指肠腺瘤 十二指肠腺癌 随访 

分 类 号：R735.3[医药卫生—肿瘤]