10例十二指肠乳头腺瘤内镜切除回顾分析  

Retrospective analysis of endoscopic resection of duodenal papilla adenoma

作　　者：程佳琪 聂泽华 游云 雷婷 陶林 聂占国 CHENG Jiaqi;NIE Zehua;YOU Yun;LEI Ting;TAO Lin;NIE Zhanguo(Graduate School of Xinjiang Medical University,Urumq 830054;Department of Gastroenterology,General Hospital of Xinjiang Military Region,Chinese PLA,China)

机构地区：[1]新疆医科大学研究生院,新疆乌鲁木齐830054 [2]中国人民解放军新疆军区总医院消化内科

出　　处：《胃肠病学和肝病学杂志》2024年第1期59-64,共6页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的 探讨内镜下十二指肠乳头腺瘤切除术的安全性和有效性。方法 回顾性分析中国人民解放军新疆军区总医院消化内镜中心2019年6月至2022年9月行内镜下十二指肠乳头腺瘤切除术的10例患者临床资料,总结其内镜表现、并发症情况、病理特点及随访情况。结果 共纳入10例患者,男8例,女2例。年龄54~73岁,平均年龄63岁。入院时合并消化不良3例,体检发现4例,无症状性胆管扩张2例,导管内延伸1例;9例患者的病变局限于壶腹部,1例为导管内延伸腺瘤;病灶的平均大小为20.4 mm(8.0~33 mm);8个病灶整块切除,2个病灶分块切除。6例置入胆胰管支架;9例完全切除,1例切缘阳性残留,成功切除率为90%。并发症发生率为40%(4/10),其中3例出血,3例轻度急性胰腺炎,1例穿孔,3例复发。管状腺瘤2例,高级别上皮内瘤变3例,绒毛状腺瘤3例,低级别上皮内瘤变1例,腺癌1例,切缘阳性(10%),肿瘤的完全阴性切缘率90%。结论 内镜下切除十二指肠乳头腺瘤是一种高风险、有效的微创治疗方式,胰管支架置入可降低胰腺炎发生率,术后应密切内镜随访及时处理复发与残留。Objective To investigate the safety and efficacy of endoscopic resection of duodenal papilla adenoma.Methods Clinical data of 10 patients undergoing endoscopic duodenal papilloma resection from the Digestive Endoscopy Center in General Hospital of Xinjiang Military Region,Chinese PLA from Jun.2019 to Sep.2022 were retrospectively analyzed,and their endoscopic manifestations,complications,pathological characteristics and follow-up were summarized.Results A total of 10 patients were included in this study,including 2 females and 8 males.Patients ranged in age from 54 to 73 years old,with an average age of 63 years old.On admission,3 cases were complicated with dyspepsia,4 cases were found by physical examination,asymptomatic biliary dilatation occurred in 2 cases.Intraductal extension in 1 case,and lesions were confined to the ampulla in 9 patients.One case was intraductal extension adenoma.The average lesion size was 20.4 mm(8.0-33.0 mm).Eight lesions were resected en masse,and 2 lesions were resected en masse.Biliary and pancreatic duct stents were implanted in 6 cases.Nine cases were completely resected,1 case had positive residual margin,and the success rate was 90%.Complication rate was 40%(4/10):3 cases bleeding;3 cases had mild acute pancreatitis,1 case perforated and 3 cases relapsed.There were 2 cases of tubular adenoma,3 cases of high-grade intraepithelial neoplasia,3 cases of villous adenoma,1 case of low-grade intraepithelial neoplasia,and 1 case of adenocarcinoma,with positive incisal margin and a completely negative incisal margin rate of 90%.Conclusion Endoscopic resection of duodenal papilla adenorma is a high-risk and effective minimally invasive treatment.Pancreatic duct stent placement can reduce the incidence of pancreatitis.Close endoscopic follow-up should be conducted after surgery to timely deal with recurrence and residual.

关 键 词：十二指肠乳头腺瘤 内镜下十二指肠乳头腺瘤切除术 并发症管理 

分 类 号：R574.51[医药卫生—消化系统]