Otowa Yasunori, Kanaji Shingo, Morita Yoshinori, Suzuki Satoshi, Yamamoto Masashi, Matsuda Yoshiko, Matsuda Takeru, Oshikiri Taro, Nakamura Tetsu, Kawara Fumiaki, Tanaka Shinwa, Ishida Tsukasa, Toyonaga Takashi, Azuma Takeshi, Kakeji Yoshihiro
Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Division of Gastrointestinal Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Endosc Int Open. 2017 Nov;5(11):E1153-E1158. doi: 10.1055/s-0043-117957. Epub 2017 Nov 8.
Endoscopic submucosal dissection (ESD) for duodenal tumors results in a high delayed perforation rate due to the thinness of the duodenal wall. In most cases with perforation after duodenal ESD, additional surgery is needed due to severe peritonitis. A newly developed procedure, laparoscopic endoscopic cooperative surgery for duodenal tumors (D-LECS), may help to avoid perforation after ESD. In our institution, patients with superficial non-ampullary duodenal epithelial tumors (SNADET) smaller than 50 mm which could not have en-bloc resection by endoscopic mucosal resection were treated with D-LECS. After a laparoscopic exposure of anterior duodenal wall of second portion, ESD was performed. Laparoscopic suturing from the serosal side of ESD site was performed for reinforcement. There were neither postoperative leakage nor other complications. Therefore, D-LECS can be performed safely and prevent perforation after ESD for SNADET. D-LECS could be selected as a treatment for SNADET which can be cured by ESD.
由于十二指肠壁薄，十二指肠肿瘤的内镜黏膜下剥离术（ESD）导致较高的延迟穿孔率。在大多数十二指肠ESD术后穿孔的病例中，由于严重的腹膜炎需要进行额外的手术。一种新开发的手术，即十二指肠肿瘤的腹腔镜内镜联合手术（D-LECS），可能有助于避免ESD术后穿孔。在我们机构，对于直径小于50毫米、无法通过内镜黏膜切除术进行整块切除的浅表非壶腹十二指肠上皮肿瘤（SNADET）患者，采用D-LECS进行治疗。在腹腔镜暴露十二指肠第二部前壁后，进行ESD。从ESD部位的浆膜侧进行腹腔镜缝合以加强。术后既无渗漏也无其他并发症。因此，D-LECS可以安全进行，并预防SNADET的ESD术后穿孔。D-LECS可作为ESD可治愈的SNADET的一种治疗选择。
