十二指肠非壶腹部病变消化内镜超级微创手术治疗的可行性分析  

Feasibility analysis of digestive endoscopic super minimally invasive surgery of non-ampullary duodenal lesions

作　　者：王立辉 吕昆明 李毅[3] 陈倩倩[3] Wang Lihui;Lyu Kunming;Li Yi;Chen Qianqian(Medical School of Chinese PLA,Beijing 100853,China;Department of Gastroenterology,the Second Medical Center of Chinese PLA General Hospital,Beijing 100853,China;Department of Digestive Endoscopy Super Minimally Invasive of Gastroenterology,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第二医学中心消化内科,北京100853 [3]解放军总医院第一医学中心消化内科医学部消化内镜超级微创科,北京100853

出　　处：《中国医师进修杂志》2024年第4期296-300,共5页Chinese Journal of Postgraduates of Medicine

基　　金：国家重点研发计划(2022YFC2503600)。

摘　　要：目的探讨十二指肠非壶腹部病变(NADLs)消化内镜超级微创手术(SMIS)治疗的可行性,为临床治疗及后续研究提供参考。方法回顾性分析2004年9月至2023年9月在解放军总医院第一医学中心行消化内镜SMIS治疗的206例NADLs患者,按治疗方法分为内镜息肉高频电切除术组(21例)、内镜黏膜切除术(EMR)组(67例)、预切开内镜黏膜切除术(Pre-cut-EMR)组(20例)、内镜黏膜下剥离术(ESD)组(97例)和内镜全层切除术(EFR)组(1例)。收集患者的术前、术中及术后情况并比较组间差异。结果ESD治疗患者比与非ESD治疗患者的牵引辅助率更高。术中穿孔发生率为3.40%(7/206),术后并发情况发生率为6.31%(13/206)。在术后并发情况方面,ESD治疗患者高于非ESD治疗患者[10.31%(10/97)比2.75%(3/109),P=0.026],降部病变患者高于非降部病变患者[11.71%(13/111)比0,P=0.001],牵引辅助内镜黏膜下剥离术患者均无术后并发情况。与无术后并发情况患者相比,有术后并发情况患者内镜下息肉长径更长[(2.36±1.36)cm比(1.62±0.93)cm,P=0.015],留置胃管率更高[8/13比27.46%(53/193),P=0.022],留置胃管天数更长[(9.25±2.96)d比(3.95±1.76)d,P<0.001],质子泵抑制剂(PPI)泵入天数更长[(9.69±3.68)d比(4.88±2.47)d,P<0.001],恢复饮食更晚[(8.17±2.82)d比(3.98±1.93)d,P<0.001],住院天数更长[(14.23±5.00)d比(6.64±2.49)d,P<0.001],一级护理天数更长[(9.23±3.77)d比(4.26±2.58)d,P<0.001]。结论针对不同NADLs情况选择合适的消化内镜SMIS治疗方式和加强术后重点处理有助于减少并发症的发生,NADLs消化内镜SMIS治疗具有可行性。Objective To evaluate the feasibility of digestive endoscopic super minimally invasive surgery(SMIS)of non-ampullary duodenal lesions(NADLs),so as to provide a certain reference for clinical treatment and follow-up research.Methods Two hundred and six patients with NADLs who underwent digestive endoscopic SMIS treatment at the First Medical Center of the PLA General Hospital from September 2004 to September 2023 were enrolled retrospectively,and they were divided into endoscopic high frequency electrical polypectomy group(21 cases),endoscopic mucosal resection(EMR)group(67 cases),precutting endoscopic mucosal resection(Pre-cut-EMR)group(20 cases),endoscopic submucosal dissection(ESD)group(97 cases)and endoscopic full thickness resection(EFR)group(1 case)according to the treatment methods.The preoperative,intraoperative and postoperative conditions of the patients were collected and the differences among the groups were compared.Results The number of endoscopic submucosal dissection with traction in the ESD-treated patients was higher than that in the non-ESD-treated patients.The incidence of intraoperative perforation was 3.40%(7/206),and the incidence of postoperative complications was 6.31%(13/206).In terms of postoperative complications,ESD-treated patients were higher than non-ESD patients:10.31%(10/97)vs.2.75%(3/109),P=0.026;descending lesions were higher than non-descending lesions:11.71%(13/111)vs.0,P=0.001;and there were no postoperative complications in endoscopic submucosal dissection with traction.Compared with patients without postoperative complications,patients with postoperative complications had longer endoscopic polyp length and diameter:(2.36±1.36)cm vs.(1.62±0.93)cm,P=0.015;the rate of indwelling gastric tube was higher in patients with postoperative complications:61.54%(8/13)vs.27.46%(53/193),P=0.022;the number of days of indwelling gastric tube was longer:(9.25±2.96)d vs.(3.95±1.76)d,P<0.001;the number of days of proton pump inhibitor pumping was longer:(9.69±3.68)d vs.(4.88±2.47)d,P<0.

关 键 词：十二指肠疾病 内窥镜黏膜切除术 手术中并发症 手术后并发症 手术后医护 

分 类 号：R656.64[医药卫生—外科学]