内镜下治疗非壶腹部早期十二指肠癌的疗效分析  

Efficacy of endoscopy for early nonampullary duodenal cancer

作　　者：隗永秋 周巧直 李鹏 冀明 牛应林 王拥军 张澍田 Wei Yongqiu;Zhou Qiaozhi;Li Peng;Ji Ming;Niu Yinglin;Wang Yongjun;Zhang Shutian(Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Faculty of Gastroenterology of Capital Medical University,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院消化内科国家消化系统疾病临床医学研究中心,首都医科大学消化病学系消化疾病癌前病变北京市重点实验室,北京100050

出　　处：《中华消化内镜杂志》2022年第5期394-398,共5页Chinese Journal of Digestive Endoscopy

基　　金：国家自然科学基金(82070575);国家重点研发计划(2017YFC0113600)。

摘　　要：目的评估内镜下治疗非壶腹部早期十二指肠癌的临床疗效。方法以2015年1月-2021年1月在首都医科大学附属北京友谊医院接受内镜下治疗的非壶腹部早期十二指肠癌患者为研究对象, 回顾性研究患者基线信息、内镜治疗方式、创面封闭方式、病理分析和并发症的发生与转归等资料。结果 47例患者资料入选并均成功完成内镜下治疗, 其中内镜黏膜切除术(endoscopic mucosal resection, EMR)17例, 内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)5例, ESD+EMR 7例, 因ESD剥离困难转为ESD+EMR 6例, 耙状金属夹闭合系统(over-the-scope clip system, OTSC)辅助的全层切除4例, 分片内镜黏膜切除术(piecemeal EMR, EPMR)8例。47例早期癌病变中, 整块切除率83.0%(39/47), 完全切除率85.1%(40/47)。全组47例中, 围手术期发生穿孔并发症4例(8.5%), 均发生于降部, 其中2例(4.3%)经内镜治疗后好转, 另外2例(4.3%)内镜治疗效果不佳, 经外科手术治疗后好转。围手术期未出现术后出血、感染等并发症。结论内镜下治疗非壶腹部早期十二指肠癌是安全有效的, 可根据病灶的位置、大小及个体情况选择有针对性的治疗方案。对于十二指肠降段的操作, 要更加警惕穿孔并发症的发生。Objective To evaluate the clinical efficacy of endoscopic treatment for early nonampullary duodenal cancer.Methods Data of patients with early nonampullary duodenal cancer,who underwent endoscopic treatment from January 2015 to January 2021 at Beijing Friendship Hospital were retrospectively analyzed.Baseline data,endoscopic treatment methods,wound closure,pathology,the occurrence and outcome of complications of patients were studied.Results A total of 47 patients who successfully went through endoscopic treatment were enrolled.Seventeen cases received endoscopic mucosal resection(EMR),5 cases received endoscopic submucosal dissection(ESD),and 7 cases received ESD+EMR(hybrid ESD).Six cases were converted to hybrid ESD due to difficulty in ESD.Four cases received full-thickness resection with over-the-scope clip system(OTSC),and 8 cases received endoscopic piecemeal mucosal resection(EPMR).Among the 47 cases of early cancer,the en bloc resection rate was 83.0%(39/47),and the complete resection rate was 85.1%(40/47).Four patients(8.5%)had perforation which occurred at the duodenal descending part during the perioperative period,among whom,2 patients(4.3%)recovered after endoscopic treatment,2 others(4.3%)recovered after surgical intervention.There were no complications such as postoperative bleeding or infection during the perioperative period.Conclusion Endoscopic treatment for early nonampullary duodenal cancer is safe and effective.A specific treatment plan can be selected according to the location,size and specific conditions of the lesion.For the operation of the descending part,it is necessary to be more vigilant to against the occurrence of perforation complications.

关 键 词：十二指肠肿瘤 内镜下粘膜切除术 内镜下治疗 内镜黏膜下剥离术 

分 类 号：R735.31[医药卫生—肿瘤]