内镜下十二指肠乳头切除术联合胆管内射频消融术治疗十二指肠乳头肿瘤合并胆管内浸润的价值  

Value of endoscopic papillectomy combined with endobiliary radio frequency ablation for duodenal papilla tumor with intraductal biliary infiltration

作　　者：王英瑜 金杭斌[2] 楼奇峰 杨建锋[2] 张筱凤[2] Wang Yingyu;Jin Hangbin;Lou Qifeng;Yang Jianfeng;Zhang Xiaofeng(The Fourth Clinical School of Zhejiang Chinese Medical University,Hangzhou 310051,China;Department of Gastroenterology,Hangzhou First People's Hospital,Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province,Hangzhou 310006,China)

机构地区：[1]浙江中医药大学第四临床医学院,杭州310051 [2]杭州市第一人民医院消化内科浙江省中西医结合胆胰疾病重点实验室,杭州310006

出　　处：《中华消化内镜杂志》2022年第6期459-463,共5页Chinese Journal of Digestive Endoscopy

基　　金：浙江省医药卫生科技计划项目(2021ZH003,2021441076);杭州市科技发展计划项目(202004A14);杭州市医学重点学科(OO20190001)。

摘　　要：目的评估内镜下十二指肠乳头切除术(endoscopic papillectomy,EP)联合胆管内射频消融术(radio frequency ablation,RFA)治疗十二指肠乳头肿瘤合并胆管内浸润的有效性与安全性。方法纳入2013年2月—2019年2月采用EP联合胆管内RFA治疗经病理组织学证实的十二指肠乳头肿瘤伴胆管内浸润的12例患者资料。总结患者的临床特征、内镜表现、内镜治疗效果和术后并发症发生情况,并随访分析复发率。结果内镜超声检查测量病变中位大小为18.5 mm×15.5 mm,胆管内侵犯长度为(14.1±5.8)mm。12例患者均成功行ER+RFA,技术成功率100%;术后病理示腺癌5例,腺瘤伴高级上皮内瘤变6例,腺瘤伴低级别上皮内瘤变1例。术后随访(28.5±10.4)个月,接受(4.1±1.6)次ERCP和胆管内活检,分别有2例患者在14个月和20个月时复发(均为腺癌)。结论EP联合胆管内RFA治疗十二指肠乳头肿瘤伴胆管内浸润是安全有效的,但考虑到复发的风险,术后需要严密随访观察。Objective To evaluate the efficacy and safety of endoscopic papillectomy(EP)combined with endobiliary radio frequency ablation(RFA)for duodenal papilla tumor with intraductal biliary infiltration.Methods Data of 12 patients with histologically confirmed duodenal papilla tumor combined with intraductal biliary infiltration treated by EP with RFA from February 2013 to February 2019 were retrospectively analyzed.Clinical characteristics,endoscopic features,treatment efficacy and postoperative complications of patients were reviewed and recurrence was followed up.Results The median diameter of lesions measured by endoscopic ultrasound was 18.5 mm×15.5 mm,and the length of intrabiliary invasion was 14.1±5.8 mm.EP combined with RFA was successfully performed in all patients with a technical success rate of 100%.Postoperative pathology showed adenocarcinoma in 5 patients,adenoma with high-grade intraepithelial neoplasia in 6 patients,and adenoma with low-grade intraepithelial neoplasia in 1 patient.Patients received mean 4.1±1.6 times of ERCP with intraductal biopsy during a mean follow-up period of 28.5±10.4 months.Recurrence occurred in 2 patients at 14 and 20 months respectively,both were adenocarcinoma.Conclusion EP combined with RFA is effective and safe for duodenal papilla tumor with intraductal biliary infiltration.However,given the risk of recurrence,close surveillance is recommended.

关 键 词：十二指肠乳头肿瘤 射频消融术 内镜超声检查 随访分析 上皮内瘤变 内镜表现 病理组织学 内镜治疗 

分 类 号：R735.31[医药卫生—肿瘤]