十二指肠降部非壶腹部散发型腺瘤内镜下的 高危征象识别及治疗效果

High-risk endoscopic features of malignant adenoma and clinical outcomes of endoscopic treatment of sporadic, non-ampullary descending duodenal adenomaShi Liangliang, Li Yang, Zhou Lin, Shen Yonghua, Ling Tingsheng

摘要:

目的评估内镜治疗十二指肠降部非壶腹部散发型腺瘤的安全性和有效性，并分析总结其内镜下高危征象。方法回顾性分析2012年11月—2019年9月于南京鼓楼医院病理确诊的十二指肠降部非壶腹部散发型腺瘤患者54例，依据病理分级将患者分为高级别上皮内瘤变（high grade intraepithelial neoplasia,HGIN）/癌变（adenocarcinoma,AC）组以及低级别上皮内瘤变（low grade intraepithelial neoplasia，LGIN）组，记录并比较2组患者性别、年龄、病变长径、病变形态、病变色泽、治疗方式、手术并发症以及术后随访等临床资料，并评估内镜下治疗效果。结果54例患者中HGIN/AC组12例，LGIN组42例，2组间病变长径以及病变色泽差异均有统计学意义（P均＜0.05）。54例患者接受相应内镜下治疗，8例较小病变予活检钳除，32例行内镜黏膜切除术治疗，14例行内镜黏膜下剥离术治疗。术中小穿孔1例，内镜下钛夹封闭，内科治疗后无并发症；2例出现术后迟发性出血，均经内镜下治疗后出血控制。术后随访2~58个月，无一例复发。结论内镜治疗十二指肠降部非壶腹部散发型腺瘤是一种安全有效的方法，病变长径>10 mm以及色泽发红时，应警惕病变恶变倾向。

Abstract:

ObjectiveTo investigate the safety and efficacy of endoscopic treatment for sporadic non-ampullary descending duodenal adenoma, and to analyze high-risk endoscopic features of malignant adenoma. MethodsData of 54 patients diagnosed as having non-ampullary descending duodenal adenoma in Nanjing Drum Tower Hospital from November 2012 to September 2019 were retrospectively studied. The patients were divided into two groups, the high-grade intraepithelial neoplasia/adenocarcinoma （HGIN/AC） group and the low-grade intraepithelial neoplasia （LGIN) group accor ding to pathological grade. Clinical features including gender, age, size and color of lesions, therapeutic methods, complications and postoperative follow-up results were analyzed. ResultsA total of 54 patients were divided into the HGIN/AC group (n=12) and the LGIN group (n=42). There were significant differences in size or color of lesions between the two groups (both P＜0.05). All 54 patients received endoscopic treatment. Biopsy, endoscopic mucosal resection and endoscopic submucosal dissection were performed on 8, 32 and 14 cases, respectively. A small perforation was found and clipped during operation without any complications. There were 2 cases of delayed hemorrhage, and the bleeding stopped under endoscopic treatment. The mean follow-up time was 2-58 months with no recurrence. ConclusionEndoscopic treatment is safe and effective for non-ampullary descending duodenal adenoma. Lesions of size larger than 10 mm and those with a red surface have higher malignant tendency.