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
程佳琪 1聂泽华 2游云 2雷婷 2陶林 2聂占国2
作者信息
- 1. 新疆医科大学研究生院,新疆 乌鲁木齐 830054;中国人民解放军新疆军区总医院消化内科
- 2. 中国人民解放军新疆军区总医院消化内科
- 折叠
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.
Abstract
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 Endosco-py Center in General Hospital of Xinjiang Military Region,Chinese PLA from Jun.2019 to Sep.2022 were retrospec-tively analyzed,and their endoscopic manifestations,complications,pathological characteristics and follow-up were sum-marized.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 dys-pepsia,4 cases were found by physical examination,asymptomatic biliary dilatation occurred in 2 cases.Intraductal ex-tension 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 resec-ted 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 ca-ses 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 treat-ment.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Key words
Duodenal papillary adenoma/Endoscopic papillectomy/Management of complications引用本文复制引用
出版年
2024
NETL
NSTL
万方数据