对比不同内镜切除方法治疗十二指肠乳头良性肿瘤的研究  

Comparison of Different Endoscopic Papillectomy of Benign Papillary Tumors

作　　者：姜梦妮 吕顺莉 张敏敏 金震东 李兆申 Jiang Mengni;Lv Shunli;Zhang Minmin(Changhai Hospital,Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院消化内科,上海200433 [2]上海市交通大学医学院附属瑞金医院,200025

出　　处：《医学研究杂志》2021年第3期61-63,109,共4页Journal of Medical Research

基　　金：上海市临床重点专科项目“振龙头”类:消化病科(长海医院)。

摘　　要：目的比较两种内镜治疗十二指肠乳头良性肿瘤方法,即圈套式乳头切除术(endoscopic snare papillectomy,ESP)和内镜下黏膜切除术(endoscopic mucosal resection,EMR),为临床决策提供更多依据。方法回顾性分析2010年5月~2019年10月于海军军医大学第一附属医院(上海长海医院)消化内科行内镜下十二指肠摘除术的89例患者临床资料,采用χ^(2)检验、Fisher精确检验、秩和检验等相关统计方法对资料进行统计分析。结果89例壶腹肿瘤患者,根据手术方式不同,分为ESP组36例、EMR组53例。术后并发症有出血(ESP组13.9%,EMR组11.3%)、胰腺炎(ESP组2.8%,EMR组1.9%)、术后感染(EMR组1.9%)和淀粉酶水平升高(ESP组38.9%,EMR组26.4%),无穿孔、胆管炎和乳头状狭窄。17例患者术后1年内腺瘤复发(ESP组13.9%,EMR组22.6%)。结论内镜下乳头切除术是一种治疗十二指肠良性病变安全有效的方法,ESP与EMR在手术并发症发生方面差异无统计学意义(P<0.05),但似乎ESP术与更低的复发率相关。Objective To provide a new evidence for the treatment of benign papillary tumors by comparing endoscopic snare papillectomy(ESP)with endoscopic mucosal resection(EMR).Methods From May 2010 to October 2019,a total of 89 patients were enrolled.The diagnosis and treatment procedures were ESP and EMR.Endoscopic follow-up evaluation was performed regularly as a monitoring measure for recurrence.Results Eighty nine patients with ampullary tumor were divided into ESP group(n=36)and EMR group(n=53).Postoperative complications included bleeding(ESP 13.9%vs EMR 11.3%),pancreatitis(ESP 2.8%vs EMR 1.9%),postoperative infection(1.9%in EMR group)and elevated amylase level(ESP 38.9%vs EMR 26.4%).No perforation,cholangitis and papillary stenosis were found.The recurrence rate was 13.9%in ESP group and 22.6%in EMR group.Conclusion Endoscopic papillectomy is a safe and effective method for the treatment of benign duodenal lesions.There is no significant difference in the incidence of surgical complications between ESP and EMR,but it seems that ESP is associated with a lower recurrence rate.

关 键 词：良性十二指肠乳头肿瘤 圈套式乳头切除术 内镜下黏膜切除术 

分 类 号：R735.3[医药卫生—肿瘤]