内镜下粘膜切片切除与内镜下粘膜剥离治疗非壶腹性十二指肠较大病变的临床观察

中华消化内镜杂志 Pub Date : 2019-12-20 DOI:10.3760/CMA.J.ISSN.1007-5232.2019.12.006

Yongqiu Wei, Qiaozhi Zhou, Peng Li, M. Ji, Shanshan Wu, B. Yue, Shutian Zhang, Si-quan Zhu

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引用次数: 0

摘要

目的评价内镜下粘膜碎片切除(EPMR)和内镜下粘膜剥离(ESD)治疗较大(≥10-15 mm)非壶腹性十二指肠病变的疗效和安全性。方法回顾性分析2013年2月至2018年8月在北京友谊医院行EPMR或ESD治疗的21例较大(≥10-15 mm)非壶腹十二指肠病变患者的资料。根据治疗方案将患者分为EPMR组(n=13)和ESD组(n=8)。总结各组手术时间、病理组织学评价及并发症情况。结果EPMR组13例病变均起源于黏膜。内镜估计病变直径为22±12 mm，切除标本大小为26±15 mm，中位手术时间为39.0 (23.0,45.0)min, 12个病变用金属夹封闭。病理检查:胃黏膜异位2例，低级别上皮内瘤变7例，高级别上皮内瘤变4例。13例中水平缘阳性5例(低级别上皮内瘤变)。2例患者出现并发症，其中1例围术期菌血症，经抗感染治疗治愈，1例术中穿孔，经急诊手术恢复。ESD组黏膜病变6例，黏膜下病变2例。内镜估计病灶直径为17±5 mm，切除标本大小为20±7 mm，中位手术时间为47.5 (34.0,68.0)min, 8个病灶均用金属夹封闭。病理检查:低级别上皮内瘤变3例，高级别上皮内瘤变3例，粘膜下囊肿1例，淋巴管瘤1例。8例水平缘均阴性，1例垂直缘怀疑低级别上皮内瘤变，未能完全切除。围手术期穿孔3例。1例经内镜治疗后痊愈，1例内镜检查不理想，经急诊手术后痊愈。另1例经腹腔镜治疗后痊愈。结论EPMR和ESD对较大的非壶腹十二指肠病变均安全有效，值得进一步临床研究。关键词:十二指肠疾病;原发性非壶腹性十二指肠病变;内镜下粘膜切片切除术;内镜下粘膜夹层

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Clinical observation of endoscopic piecemeal mucosal resection and endoscopic submucosal dissection in the treatment of larger non-ampullary duodenal lesions

Objective To assess the efficacy and safety of endoscopic piecemeal mucosal resection (EPMR) and endoscopic submucosal dissection (ESD) in the treatment of larger (≥10-15 mm) non-ampullary duodenal lesions. Methods The data of 21 patients with larger (≥10-15 mm) non-ampullary duodenal lesions, who underwent EPMR or ESD in Beijing Friendship Hospital from February 2013 to August 2018 were retrospectively analyzed. According to the treatment plan, the patients were divided into the EPMR group (n=13) and the ESD group (n=8). The operation time, pathological histological evaluation and complications of each group were summarized. Results In the EPMR group, all 13 lesions were originated from the mucosa. The diameter of the lesion estimated by endoscopy and the size of the resected specimen were 22±12 mm and 26±15 mm, respectively, the median operation time was 39.0 (23.0, 45.0) min, and 12 lesions were closed with metal clips. For pathological assessment, there were 2 cases of ectopia gastric mucosa, 7 cases of low grade intraepithelial neoplasia, and 4 cases of high grade intraepithelial neoplasia. And 5 cases were horizontal margin positive (low grade intraepithelial neoplasia) in the 13 lesions. Complications occurred in 2 patients, including 1 case of perioperative bacteremia, which was cured after anti-infective treatment, and another case of intraoperative perforation, which was recovered after emergency surgery. In the ESD group, there were 6 mucosal lesions and 2 submucosal lesions. The diameter of the lesion estimated by endoscopy and the size of the resected specimen were 17±5 mm and 20±7 mm, respectively, the median operation time was 47.5 (34.0, 68.0) min, and all 8 lesions were closed with metal clips. For pathological assessment, there were 3 cases of low grade intraepithelial neoplasia, 3 cases of high grade intraepithelial neoplasia, 1 case of submucosal cyst, and 1 case of lymphangioma. All 8 cases were horizontal margin negative, and low-grade intraepithelial neoplasia was suspected at the vertical margin of 1 case, which failed to achieve complete resection. Perioperative perforation occurred in 3 cases. One case recovered after endoscopic treatment, another case was unsatisfactory under endoscopy, and recovered after emergency surgery. The other case was recovered after laparoscopic treatment. Conclusion EPMR and ESD are both safe and effective for larger non-ampullary duodenal lesions, which is worthy of further clinical research. Key words: Duodenal diseases; Primary non-ampullary duodenal lesion; Endoscopic piecemeal mucosal resection; Endoscopic submucosal dissection

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来源期刊

中华消化内镜杂志

CiteScore

0.10

自引率

0.00%

发文量

7555

期刊介绍： Chinese Journal of Digestive Endoscopy is a high-level medical academic journal specializing in digestive endoscopy, which was renamed Chinese Journal of Digestive Endoscopy in August 1996 from Endoscopy. Chinese Journal of Digestive Endoscopy mainly reports the leading scientific research results of esophagoscopy, gastroscopy, duodenoscopy, choledochoscopy, laparoscopy, colorectoscopy, small enteroscopy, sigmoidoscopy, etc. and the progress of their equipments and technologies at home and abroad, as well as the clinical diagnosis and treatment experience. The main columns are: treatises, abstracts of treatises, clinical reports, technical exchanges, special case reports and endoscopic complications. The target readers are digestive system diseases and digestive endoscopy workers who are engaged in medical treatment, teaching and scientific research. Chinese Journal of Digestive Endoscopy has been indexed by ISTIC, PKU, CSAD, WPRIM.