论著 · Article

内镜切除十二指肠肿瘤的初步临床应用

International Expert Consensus and Current Situation Interpretation of Volatile Organic Compounds in Human Assisted Reproductive Laboratory Environment

作者：王小鹏¹，贾荣杰¹，王景华²，崔海宏¹，秦锐¹，乔海滨¹，李海宽¹，张振华^1,*

¹解放军第三O五医院消化科北京

²解放军第三O五医院麻醉科北京

^*通信作者：张振华；单位：解放军第三O五医院，消化科，北京

提交：2022-02-28修改：2022-03-02录用：2022-05-26出版：2022-06-23

环球医学进展, 2022, 1(1), 13-19

课题资助：自筹经费，无利益冲突需要说明

摘要：

摘要：目的：探讨内镜切除十二指肠肿瘤的疗效和安全性。方法：对2012年10月至2021年12月间15例接受过内镜下十二指肠肿瘤切除治疗的患者进行回顾性调查。调查内容包括：患者的个人资料，肿瘤的发生部位、大小，内镜切除方法，术后病理诊断以及随访情况等。结果：15例患者中，男11例，女4例，年龄32～71岁，平均52岁。十二指肠乳头病变8例（53%），降部（非乳头部位）病变3例，球部【更多...】

关键字：十二指肠肿瘤；内镜切除；术后病理诊断

关键词： 十二指肠肿瘤；内镜切除；术后病理诊断

摘要

摘要：

目的：探讨内镜切除十二指肠肿瘤的疗效和安全性。方法：对2012年10月至2021年12月间15例接受过内镜下十二指肠肿瘤切除治疗的患者进行回顾性调查。调查内容包括：患者的个人资料，肿瘤的发生部位、大小，内镜切除方法，术后病理诊断以及随访情况等。结果：15例患者中，男11例，女4例，年龄32～71岁，平均52岁。十二指肠乳头病变8例（53%），降部（非乳头部位）病变3例，球部病变2例，球部、水平部多发病变1例，降部、水平部多发病变1例。病变最大直径0.6～8.0cm，中位数为1.8cm。内镜手术情况：乳头切除术治疗8例次，内镜黏膜切除术治疗3例次，内镜黏膜下剥离术治疗5例次。内镜操作时间42～161min，中位数为50min。15例病变中，12例（80%）成功于内镜下完全切除；3例内镜下仅部分切除，中转外科开腹手术后完全切除。术后病理证实：腺瘤8例（53%），类癌3例，腺瘤性息肉2例、平滑肌瘤1例，间质瘤1例。成功完成内镜下肿瘤切除治疗的12例患者中，术后出现并发症3例（3%），其中出血2例，穿孔1例，均通过保守治疗成功控制；随访3～60个月，中位数为9个月，1例（8%）于术后2个月复发，再次行内镜下肿瘤切除治疗，术后随访4个月未见异常。结论：短期随访表明，内镜切除十二指肠肿瘤安全、有效。在外科医生的协同配合下，更多的十二指肠肿瘤可以优先尝试通过内镜切除进行治疗，从而减少开腹手术。

关键字：十二指肠肿瘤；内镜切除；术后病理诊断

Abstract：

Objective: To investigate the efficacy and safety of endoscopic resection of duodenal neoplasms. Methods: A retrospective investigation was conducted on 15 patients who underwent endoscopic resection of duodenal tumors from October 2012 to December 2021. The questionnaire included: the patient's personal data, the location and size of the tumor, the method of endoscopic resection, postoperative pathological diagnosis and follow-up. Results: There were 11 males and 4 females with an average age of 52 years (range, 32-71 years). There were 8 cases (53%) of duodenal papilla lesions, 3 cases of descending part (non-papillary part) lesions, 2 cases of bulb lesions, 1 case of multiple lesions in bulb and horizontal part, and 1 case of multiple lesions in descending part and horizontal part. The maximum diameter of the lesions was 0.6-8.0 cm, with a median of 1.8cm. Endoscopic surgery: papillectomy was performed in 8 cases, endoscopic mucosal resection in 3 cases, and endoscopic submucosal dissection in 5 cases. The median endoscopic procedure time was 50min (range 42-161 min). Of the 15 lesions, 12 (80%) were successfully completely resected under endoscopy. Three cases were only partially resected under endoscopy and completely resected after conversion to open surgery. Postoperative pathology confirmed adenoma in 8 cases (53%), carcinoid in 3 cases, adenomatous polyp in 2 cases, leiomyoma in 1 case, and stromal tumor in 1 case. Among the 12 patients who successfully underwent endoscopic tumor resection, 3 patients (3%) had postoperative complications, including 2 cases of bleeding and 1 case of perforation, which were successfully controlled by conservative treatment. The median follow-up time was 9 months (range 3-60 months). One patient (8%) had tumor recurrence 2 months after surgery and underwent endoscopic tumor resection again, and no abnormality was found 4 months after surgery. Conclusions: Endoscopic resection of duodenal neoplasms is safe and effective in short-term follow-up. With a concerted effort by surgeons, more duodenal tumors could be preferentially attempted to be treated by endoscopic resection, resulting in less open surgery.

Keywords: Tumors of the duodenum; Endoscopic resection; Postoperative Pathological diagnosis

正文

正文内容 / Content：

可下载全文PDF查阅，并按照本文版权申明进行使用。

Download the full text PDF for viewing and using it according to the license of this paper.

参考文献

参考文献 / References：

Galandiuk S, Hermann RE, Jagelman DG, et al. Villous tumors of the duodenum. Ann Surg, 1988, 207(3): 234-9.
Seifert E, Schulte F, Stolte M. Adenoma and carcinoma of the duodenum and papilla of Vater: a clinicopathologic study. Am J Gastroenterol, 1992,87(1):37-42.
Kim HK, Chung WC, Lee BI, et al. Efficacy and long-term outcome of endoscopic treatment of sporadic nonampullary duodenal adenoma. Gut Liver, 2010, 4(3): 373-7.
Krukowski ZH, Ewen SW, Davidson AI, et al. Operative management of tubulovillous neoplasms of the duodenum and ampulla. Br J Surg, 1988, 75(2): 150-3.
Kaminski N, Shaham D, Eliakim R. Primary tumours of the duodenum. Postgrad Med J, 1993, 69(808): 136-8.
Bal A, Joshi K, Vaiphei K, et al. Primary duodenal neoplasms: a retrospective clinico-pathological analysis. World J Gastroenterol, 2007, 13(7): 1108-11.
Rangiah DS, Cox M, Richardson M, et al. Small bowel tumours: a 10 year experience in four Sydney teaching hospitals. ANZ J Surg, 2004, 74(9): 788-92.
Wei CJ, Chiang JH, Lin WC, et al. Tumor and tumor-like lesions of duodenum: CT and barium imaging features. Clin Imaging, 2003, 27(2): 89-96.
Markova I, Kluchova K, Zboril R, et al. Small bowel imaging - still a radiologic approach. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2010, 154(2): 123-32.
Xu GQ, Wu YQ, Wang LJ, et al. Values of endoscopic ultrasonography for diagnosis and treatment of duodenal protruding lesions. J Zhejiang Univ Sci B, 2008, 9(4): 329-34.
Hernandez LV, Catalano MF. Endoscopic papillectomy. Curr Opin Gastroenterol, 2008, 24(5): 617-22.
Yan JQ, Peng CH, Yang WP, et al. Surgical management of benign duodenal tumours. ANZ J Surg, 2010, 80(7-8): 526-30.
Zadorova Z, Dvofak M, Hajer J. Endoscopic therapy of benign tumors of the papilla of Vater. Endoscopy, 2001, 33(4): 345-7.
Bohnacker S, Seitz U, Nguyen D, et al.. Endoscopic resection of benign tumors of the duodenal papilla without and with intraductal growth. Gastrointest Endosc, 2005, 62(4): 551-60.
Honda T, Yamamoto H, Osawa H, et al. Endoscopic submucosal dissection for superficial duodenal neoplasms. Dig Endosc, 2009, 21(4): 270-4.
Sohn JW, Jeon SW, Cho CM, et al. Endoscopic resection of duodenal neoplasms: a single-center study. Surg Endosc, 2010, 24(12): 3195-200.
Ito K, Fujita N, Noda Y. Endoscopic diagnosis and treatment of ampullary neoplasm (with video). Dig Endosc, 2011, 23(2): 113-7.
Han J, Kim MH. Endoscopic papillectomy for adenomas of the major duodenal papilla (with video). Gastrointest Endosc, 2006, 63(2): 292-301.
Maguchi H. TK, Katanuma A. HT, Yoshida A. Indication of endoscopic papillectomy for tumors of the papilla of Vater and its problems. Dig Endosc, 2003, 15(SUPPL.): S33-S35.
Cheng CL, Sherman S, Fogel EL, et al. Endoscopic snare papillectomy for tumors of the duodenal papillae. Gastrointest Endosc, 2004, 60(5): 757-64.
Catalano MF, Linder JD, Chak A, et al. Endoscopic management of adenoma of the major duodenal papilla. Gastrointest Endosc, 2004, 59(2): 225-32.
Harano M, Ryozawa S, Iwano H, et al. Clinical impact of endoscopic papillectomy for benign-malignant borderline lesions of the major duodenal papilla. J Hepatobiliary Pancreat Sci, 2011, 18(2): 190-4.
Binmoeller KF, Boaventura S, Ramsperger K, et al. Endoscopic snare excision of benign adenomas of the papilla of Vater. Gastrointest Endosc, 1993, 39(2): 127-31.
Norton ID, Gostout CJ, Baron TH, et al. Safety and outcome of endoscopic snare excision of the major duodenal papilla. Gastrointest Endosc, 2002, 56(2): 239-43.
Bohnacker S, Soehendra N, Maguchi H, et al. Endoscopic resection of benign tumors of the papilla of vater. Endoscopy, 2006, 38(5): 521-5.
Yamao T, Isomoto H, Kohno S, et al. Endoscopic snare papillectomy with biliary and pancreatic stent placement for tumors of the major duodenal papilla. Surg Endosc, 2010, 24(1): 119-24.
Farnell MB, Sakorafas GH, Sarr MG, et al. Villous tumors of the duodenum: reappraisal of local vs. extended resection. J Gastrointest Surg, 2000, 4(1): 13-21.