内镜黏膜下剥离术治疗十二指肠病变的临床疗效分析

Efficacy of endoscopic submucosal dissection for duodenal lesions

摘要:

目的 评价内镜黏膜下剥离术（ESD）治疗十二指肠病变的临床疗效及安全性。方法 回顾性分析2011年1月至2019年5月在中南大学湘雅二医院消化内科行ESD治疗的45例（共46个病变）十二指肠病变患者的临床资料，对病变特点，整块切除率，完整切除率，手术并发症，术后病理和复发情况进行统计分析。结果 45例患者中男20例、女25例，年龄（52.0±11.8）岁。46个病变中位于十二指肠球部31个（67.4%），降部12个（26.1%），球降交界部3个（6.5%）。病变直径（2.4±1.9）cm。病变起源于黏膜层14个（30.4%），黏膜下层29个（63.0%），固有肌层3个（6.5%）。术后病理Brunner腺瘤11个（23.9%），神经内分泌肿瘤9个(19.6%)，异位胰腺5个(10.9%)，脂肪瘤5个(10.9%)，其他16个(34.8%)。45例患者46个病变均顺利完成ESD，病变整块切除率100%（46/46），完整切除率为91.3%（42/46）。术中出血1例（2.2%），内镜下成功止血；迟发性穿孔1例（2.2%），行急诊外科手术治疗；电凝综合征1例（2.2%），内科保守治疗好转。术后2例患者追加外科手术治疗。患者平均住院时间6.2 d（2~21 d），无一例死亡。随访41例，平均随访时间30个月（1~78个月），随访期间1例（2.4%）复发。结论 ESD治疗十二指肠病变安全、有效，具有较好的临床应用价值。

Abstract:

Objective To evaluate the clinical efficacy and safety of endoscopic submucosal dissection (ESD) for treatment of duodenal lesions. Methods A retrospective analysis was performed on the data of 45 patients (46 lesions) with duodenal lesions who underwent ESD at the Second Xiangya Hospital of Central South University from January 2011 to May 2019. The lesion features, en bloc resection rate, complete resection rate, complications, postoperative pathology and recurrence were assessed. Results Among the 45 patients, 20 were males and 25 were females, with mean age of 52.0±11.8 years. Of the 46 lesions, 31 (67.4%) located in the duodenal bulb, 12 (26.1%) in the descending part, and 3 (6.5%) at the junction of bulb and descending part. The mean diameter of the lesions was 2.4±1.9 cm (range, 0.4-10.0 cm). There were 14 (30.4%) lesions originated from mucosal layer, 29 (63.0%) from submucosal layer, and 3 (6.5%) from muscularis propria. Postoperative pathology showed 11 (23.9%) cases of Brunner’s gland tumors, 9 (19.6%) neuroendocrine tumors, 5 (10.9%) ectopic pancreas, 5 (10.9%) lipomas, and 16 (34.8%) other pathological patterns. All 45 patients with 46 lesions underwent ESD successfully, and the en bloc resection rate was 100%, complete resection rate was 91.3% (42/46). Intraoperative bleeding occurred in 1 case (2.2%), which was successfully treated by endoscopy. One (2.2%) delayed perforation occurred and was treated by surgical intervention. Electrocoagulation syndrome occurred in 1 case, which was relieved after consevertive medical therapy. 2 cases received further surgery after ESD. The mean hospital stay was 6.2 days (range, 2-21 days) and no death occurred. Fourty-one cases were followed up for 1-78 months, with mean time of 30 months. During the follow-up period, local recurrence occurred in 1 patient (2.4%). Conclusion ESD is an effective and safe treatment for duodenal lesions and has a good clinical practical value.