Ichikawa Daisuke, Komatsu Shuhei, Dohi Osamu, Naito Yuji, Kosuga Toshiyuki, Kamada Kazuhiro, Okamoto Kazuma, Itoh Yoshito, Otsuji Eigo
Daisuke Ichikawa, Shuhei Komatsu, Toshiyuki Kosuga, Kazuma Okamoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 6028566, Japan.
World J Gastroenterol. 2016 Dec 21;22(47):10424-10431. doi: 10.3748/wjg.v22.i47.10424.
To assess the safety and feasibility of laparoscopic and endoscopic co-operative surgery (LECS) for early non-ampullary duodenal tumors.
Twelve patients with a non-ampullary duodenal tumor underwent LECS at our hospital. One patient had two mucosal lesions in the duodenum. The indication for this procedure was the presence of duodenal tumors with a low risk for lymph node metastasis. In particular, the tumors included small (less than 10 mm) submucosal tumors (SMT) and epithelial mucosal tumors, such as mucosal cancers or large mucosal adenomas with malignant suspicion. The LECS procedures, such as full-thickness dissection for SMT and laparoscopic reinforcement after endoscopic submucosal dissection (ESD) for epithelial tumors, were performed for the 13 early duodenal lesions in 12 patients. Here we present the short-term outcomes and evaluate the safety and feasibility of this new technique.
Two SMT-like lesions and eleven superficial epithelial tumor-like lesions were observed. Seven and Six lesions were located in the second and third parts of the duodenum, respectively. All lesions were successfully resected . The defect in the duodenal wall was manually sutured after resection of the duodenal SMT. For epithelial duodenal tumors, the ulcer bed was laparoscopically reinforced manual suturing after ESD. Intraoperative perforation occurred in two out of eleven epithelial tumor-like lesions during ESD; however, they were successfully laparoscopically repaired. The median operative time and intraoperative estimated blood loss were 322 min and 0 mL, respectively. Histological examination of the tumors revealed one adenoma with moderate atypia, ten adenocarcinomas, and two neuroendocrine tumors. No severe postoperative complications (Clavien-Dindo classification grade III or higher) were reported in this series, but minor leakage secondary to pancreatic fistula occurred in one patient.
LECS can be a safe and minimally invasive treatment option for non-ampullary early duodenal tumors.
评估腹腔镜与内镜联合手术（LECS）治疗早期非壶腹十二指肠肿瘤的安全性和可行性。
12例非壶腹十二指肠肿瘤患者在我院接受了LECS手术。1例患者十二指肠有两处黏膜病变。该手术的适应证为十二指肠肿瘤且淋巴结转移风险低。具体而言，肿瘤包括小（小于10毫米）的黏膜下肿瘤（SMT）和上皮黏膜肿瘤，如黏膜癌或怀疑有恶变的大黏膜腺瘤。对12例患者的13处早期十二指肠病变进行了LECS手术，如对SMT进行全层剥离，对上皮肿瘤在内镜黏膜下剥离（ESD）后进行腹腔镜加固。在此我们展示短期结果并评估这项新技术的安全性和可行性。
观察到2处SMT样病变和11处浅表上皮肿瘤样病变。分别有7处和6处病变位于十二指肠第二部和第三部。所有病变均成功切除。十二指肠SMT切除后，十二指肠壁缺损采用手工缝合。对于十二指肠上皮肿瘤，ESD后溃疡床采用腹腔镜加固和手工缝合。11处上皮肿瘤样病变中有2处在ESD术中发生穿孔；然而，均成功通过腹腔镜修复。中位手术时间和术中估计失血量分别为322分钟和0毫升。肿瘤组织学检查显示1例中度异型腺瘤、10例腺癌和2例神经内分泌肿瘤。本系列未报告严重术后并发症（Clavien-Dindo分级III级或更高），但1例患者发生了继发于胰瘘的轻微渗漏。
LECS可作为非壶腹早期十二指肠肿瘤安全且微创的治疗选择。
