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内镜黏膜下剥离术治疗十二指肠病变的临床疗效:手术技术和并发症处理。

Clinical Efficacy of Endoscopic Submucosal Dissection for the Treatment of Duodenal Lesions in Terms of Operative Technique and Management of Complications.

机构信息

Department of Gastroenterology, Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.

出版信息

J Laparoendosc Adv Surg Tech A. 2022 Jul;32(7):787-793. doi: 10.1089/lap.2022.0148. Epub 2022 May 16.

Abstract

Duodenal endoscopic submucosal dissection (ESD) has been considered to be the most challenging because of its high incidence of complications, which has hindered the development of duodenal ESD. The aim of this study is to discuss operation tips for duodenal ESD and to assess the efficacy and safety of duodenal ESD. Eighty-two patients who underwent ESD in the digestive endoscope center for superficial duodenal epithelial tumors (SDETs) from January 2017 to June 2021 were studied. Patients were divided into three groups according to the occurrence of complications, and the clinical characteristics and surgical efficacy of each group were compared. SDETs in 82 patients were completely removed by ESD, with a 97.5% R0 resection rate. The average size of resected lesions was 23.8 ± 6.5 mm. There were significant differences in lesion size and operation time between the normal and intraprocedural complication groups ( < .05). Similarly, between the normal and delayed complication groups, significant differences were noted in lesion location, size, operation time, occupied circumference, and postoperative hospitalization duration ( < .05). Duodenal ESD is prone to complications that increase the complexity of the procedure. By improving the necessary technique and skills, duodenal ESD remains safe and effective.

摘要

十二指肠内镜黏膜下剥离术(ESD)因其并发症发生率高而被认为是最具挑战性的,这阻碍了十二指肠 ESD 的发展。本研究旨在探讨十二指肠 ESD 的手术技巧,并评估十二指肠 ESD 的疗效和安全性。

本研究回顾性分析 2017 年 1 月至 2021 年 6 月在消化内镜中心接受内镜下治疗的 82 例十二指肠黏膜上皮浅表肿瘤(SDET)患者的临床资料。根据并发症的发生情况将患者分为三组,比较各组的临床特征和手术效果。

82 例患者均成功完成 ESD 治疗,整块切除率为 97.5%(82/84),R0 切除率为 95.2%(78/82)。切除标本的平均直径为 23.8±6.5mm。术中并发症组和无并发症组患者的病变大小和手术时间比较,差异有统计学意义(P<0.05)。同样,在正常组和延迟性并发症组之间,病变位置、大小、手术时间、占据周长和术后住院时间差异有统计学意义(P<0.05)。

十二指肠 ESD 容易发生并发症,增加了手术的复杂性。通过提高必要的技术和技能,十二指肠 ESD 仍然是安全有效的。

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