Takahashi Tsunehiro, Ando Takashi, Kabeshima Yasuo, Kawakubo Hirofumi, Shito Masaya, Sugiura Hitoshi, Omori Tai
Department of Surgery, Kawasaki Municipal Hospital, Kanagawa, Japan.
Scand J Gastroenterol. 2009;44(11):1377-83. doi: 10.3109/00365520903287551.
OBJECTIVE. Due to advances in endoscopic equipment, primary duodenal tumors are found more frequently than in the past. We performed endoscopic submucosal dissection (ESD) to diagnose and treat four non-ampullary duodenal tumors. MATERIAL AND METHODS. During endoscopic treatment, marks were placed around the circumference of the tumor and sufficient amounts of physiological saline with epinephrine were injected into the submucosal layer to elevate the lesion. An incision was made around the lesion using a long-type needle knife and the isolated lesion was resected completely "en bloc". In this procedure, a cylindrical transparent hood was attached to the endoscopy apparatus to allow for satisfactory visualization of the procedure. RESULTS. The mean age of the patients was 69 years. The patients consisted of two males and two females. Gross examination showed three flat, elevated lesions and one polypoid lesion. Tumor size ranged from 10 to 31 mm in maximum diameter. Histological examination revealed two cases of well-differentiated adenocarcinomas and two cases of tubular adenomas with severe atypia. Procedure-related complications consisting of perforation occurred in two cases and were resolved under close postoperative observation including antibiotics, use of a nasogastric tube and nil per oral feeding status. The mean follow-up period was 18 months and none of the patients experienced tumor recurrence after the treatment. CONCLUSIONS. Since tissue obtained from endoscopic biopsies can sometimes prove difficult for definitive histological diagnosis, ESD may play an important role in the management of cases appearing to border on malignancy. In addition, ESD allows for minimally invasive treatment without sacrificing the possibility of cure for duodenal carcinoma.
目的。由于内镜设备的进步，原发性十二指肠肿瘤的发现比过去更为频繁。我们进行了内镜黏膜下剥离术（ESD）来诊断和治疗4例非壶腹十二指肠肿瘤。材料与方法。在内镜治疗过程中，在肿瘤周围做标记，并向黏膜下层注射足量含肾上腺素的生理盐水以抬高病变。使用长型针刀在病变周围切开，完整切除分离的病变组织。在此过程中，在内镜设备上连接一个圆柱形透明帽，以便能满意地观察手术过程。结果。患者的平均年龄为69岁。患者包括2名男性和2名女性。大体检查显示3个扁平隆起性病变和1个息肉样病变。肿瘤最大直径范围为10至31毫米。组织学检查显示2例高分化腺癌和2例重度异型增生的管状腺瘤。手术相关并发症包括2例穿孔，经术后密切观察包括使用抗生素、鼻胃管及禁食等情况后得到解决。平均随访期为18个月，治疗后所有患者均未出现肿瘤复发。结论。由于内镜活检获取的组织有时难以进行明确的组织学诊断，ESD在处理疑似恶性病变的病例中可能发挥重要作用。此外，ESD允许进行微创治疗，同时不牺牲十二指肠癌的治愈可能性。
