十二指肠肿瘤腹腔镜内镜联合手术治疗的现状:合适的内镜切除方法。

IF 3.6 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Digestion Pub Date : 2025-08-13 DOI:10.1159/000547890
Hiroyuki Yamamoto, Shoichi Yoshimizu, Masaru Hayami, Kosuke Tanaka, Makoto Tamamushi, Koyo Kido, Wataru Kurihara, Chika Fukuyama, Yusuke Horiuchi, Toshiyuki Yoshio, Toshiaki Hirasawa, Souya Nunobe
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引用次数: 0

摘要

十二指肠腹腔镜内镜联合手术(D-LECS)是治疗十二指肠肿瘤的一种很有前途的混合方法,包括浅表非壶腹性十二指肠上皮肿瘤(SNADETs)和上皮下病变(SELs)。该方法旨在减少不良事件(ae),如延迟穿孔,通常与内镜下粘膜剥离(ESD)相关。结合腹腔镜十二指肠稳定技术和精确内镜切除术,D-LECS可以提供更安全、更全面的治疗。然而,很少有研究将D-LECS与ESD和全层切除术(FTR)的结果进行比较,并且D-LECS合适的内镜切除方式尚不清楚。方法:我们回顾性回顾了2011年至2024年在我院接受十二指肠肿瘤D-LECS治疗的80例患者。56例患者接受了伴有ESD的D-LECS (ESD组),而24例患者接受了伴有FTR的D-LECS(16例SELs和8例snadet) (FTR组)。所有患者均行整体切除,R0总切除率为92.5%。结果:ESD组与FTR组之间Clavien-Dindo II级及以上ae的总发生率无显著差异。而ESD组胃排空延迟较少,炎症反应较高(P=0.087, P=0.063)。FTR组1例出现延迟穿孔,ESD组2例出现延迟出血。然而,这些事件并不显著。结论:D-LECS联合ESD和FTR均是安全有效的。带ESD的D-LECS可能更适合用于snadet,而带FTR的D-LECS更适合用于SELs。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Current Management of Laparoscopic and Endoscopic Cooperative Surgery for Duodenal Neoplasia: Suitable Endoscopic Resection Approaches.

Introduction: Duodenal laparoscopic and endoscopic cooperative surgery (D-LECS) is a promising hybrid approach to managing duodenal neoplasia, including superficial non-ampullary duodenal epithelial tumors (SNADETs) and subepithelial lesions (SELs). This approach aims to reduce adverse events (AEs), such as delayed perforation, often associated with endoscopic submucosal dissection (ESD). Combining laparoscopic techniques for duodenal stabilization with precise endoscopic resection, D-LECS may provide safer and more comprehensive treatment. However, few studies have compared the outcomes of D-LECS with those of ESD and full-thickness resection (FTR), and suitable endoscopic resection approaches for D-LECS remain unclear.

Methods: We retrospectively reviewed records of 80 patients who underwent D-LECS for duodenal neoplasia at our institution between 2011 and 2024. Fifty-six patients underwent D-LECS with ESD for SNADETs (ESD group), whereas 24 underwent D-LECS with FTR for 16 SELs and 8 SNADETs (FTR group). All patients underwent en bloc resection, showing an overall R0 resection rate of 92.5%.

Results: There was no significant difference in overall incidence of Clavien-Dindo grade II or higher AEs between the ESD and FTR groups. However, the ESD group tended to have fewer cases of delayed gastric emptying and higher inflammatory response (p = 0.087 and p = 0.063, respectively). One patient in the FTR group experienced delayed perforation and 2 patients in the ESD group experienced delayed bleeding. However, these events were not significant.

Conclusions: Both D-LECS with ESD and FTR were effective and safe. D-LECS with ESD may be a more suitable approach for SNADETs, whereas D-LECS with FTR is preferable for SELs.

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来源期刊
Digestion
Digestion 医学-胃肠肝病学
CiteScore
7.90
自引率
0.00%
发文量
39
审稿时长
6-12 weeks
期刊介绍: ''Digestion'' concentrates on clinical research reports: in addition to editorials and reviews, the journal features sections on Stomach/Esophagus, Bowel, Neuro-Gastroenterology, Liver/Bile, Pancreas, Metabolism/Nutrition and Gastrointestinal Oncology. Papers cover physiology in humans, metabolic studies and clinical work on the etiology, diagnosis, and therapy of human diseases. It is thus especially cut out for gastroenterologists employed in hospitals and outpatient units. Moreover, the journal''s coverage of studies on the metabolism and effects of therapeutic drugs carries considerable value for clinicians and investigators beyond the immediate field of gastroenterology.
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