摘要
目的评价内镜下十二指肠乳头切除术在十二指肠乳头腺瘤治疗中的有效性及安全性。方法回顾性分析2014年1月至2017年12月首都医科大学附属北京友谊医院收治的25例十二指肠乳头腺瘤患者的临床资料,总结其内镜表现、并发症情况、病理特点、影像学表现及随访情况。结果 25例患者中,男性11例,女性14例;年龄38~87岁;中位年龄58. 5岁。7例患者行胰十二指肠切除术。18例(18/25,72%)患者行内镜下十二指肠乳头切除术,完整切除率94. 4%(17/18);病变大小为:3例<10 mm,8例10~19 mm,6例20~29 mm,1例30 mm。术中出血2例(2/18,11. 1%),高淀粉酶血症3例(3/18,16. 7%),轻度急性胰腺炎5例(5/18,27. 8%),穿孔0例。术后病理示11例为低级别上皮内瘤变,7例为高级别上皮内瘤变。7例(7/25,28%)患者术前术后病理诊断不一致。10例影像学提示十二指肠乳头处结节样改变或软组织信号影。术后患者行胃镜随访,随访时间9~36个月,中位随访时间14. 5个月。术后复发1例(1/18,5. 6%),残留2例(2/18,11. 1%)。7例(7/25,28. 0%)患者行胰十二指肠切除术。结论内镜下十二指肠乳头切除术治疗十二指肠乳头腺瘤安全有效,但仍需密切随访。
Objective To evaluate the safety and efficacy of endoscopic papillectomy( EP) for duodenal papillary adenoma. Methods 25 patients who had duodenal papillary adenoma admitted in Beijing Friendship Hospital,Capital Medical University from January 2014 to December2017 were enrolled in this retrospective study. Their clinical data including endoscopic features,complications,pathological characteristics,radiologic characteristics and surveillance were analyzed. Results Among the 25 patients,11 were male and 14 were female;the age ranged from 38 to 87 years old;the median age was 58. 5 years. Seven patients underwent pancreatoduodenectomy. Eighteen( 18/25,72%) patients underwent EP,with a complete resection rate of 94. 4%( 17/18);the lesion size was: 3 cases < 10 mm,8 cases 10 ~ 19 mm,6 cases were 20-29 mm,1 case 30 mm.Procedure-related complications were: intraoperative bleeding in 2 cases( 2/18,11. 1%),hyperamylasemia in 3 cases( 3/18,16. 7%),mild acute pancreatitis in 5 cases( 5/18,27. 8%),and no perforation occurred. The final pathology showed 11 cases of low grade dysplasia and 7 cases of high grade dysplasia. 7 cases( 7/25,28%) had discrepant result between biopsy and final histology. Radiology images showed 10 cases of nodular changes in duodenal papilla or soft tissue signal. The patients had surveillance gastroscope after EP,the median follow-up was 14. 5 months( range9 ~ 36 months). 1 cases( 1/18,5. 56%) had recurrent lesion,2 cases( 2/18,11. 1%) had residual lesions. 7 cases( 7/25,28%) had pancreaticoduodenectomy. Conclusion EP is a safe and effective method for duodenal papillary adenoma,but surveillance is still needed.
作者
胡海一
张澍田
HU Hai-yi;ZHANG Shu-tian(Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Beijing Digestive Disease Center,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases,Beijing,100050,China)
出处
《临床和实验医学杂志》
2020年第4期415-417,共3页
Journal of Clinical and Experimental Medicine
基金
首都医科大学基础-临床科研合作基金(编号:16JL46)
作者简介
通讯作者:张澍田,E-mail:zhangshutian@ccmu.edu.cn。
