Aoki Hikaru, Kawada Hironori, Fujiwara Yumiko, Tashima Misaki, Hanabata Yusuke, Izumi Ai, Matsui Jun, Nishitai Ryuta
Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.
Asian J Endosc Surg. 2023 Oct;16(4):809-813. doi: 10.1111/ases.13223. Epub 2023 Jul 2.
The therapeutic strategy for superficial nonampullary duodenal epithelial tumors remains controversial. We developed a novel surgical technique for superficial nonampullary duodenal epithelial tumors. We report the initial two cases managed with this method.
We endoscopically confirmed the tumor location and circumferentially incised the seromuscular layer of the duodenum along it. After circumferential seromyotomy, the submucosal layer was expanded by endoscopic insufflation, and the target lesion was sufficiently lifted. The submucosal layer, including the target lesion, was stapled and resected after confirming the absence of problems with endoscopic passage. The seromuscular layer was continuously sutured to bury and reinforce the stapler line. Single-incision laparoscopic surgery was performed in one case. The resected specimens measured 52 × 32 mm and 50 × 26 mm with negative surgical margins. Both patients were discharged without complications and demonstrated no evidence of stenosis.
Compared with previously reported procedures, this method of partial duodenectomy with seromyotomy for superficial nonampullary duodenal epithelial tumors is promising, simple, and safe.
浅表性非壶腹十二指肠上皮肿瘤的治疗策略仍存在争议。我们开发了一种用于浅表性非壶腹十二指肠上皮肿瘤的新型手术技术。我们报告了最初采用这种方法治疗的两例病例。
我们通过内镜确认肿瘤位置，并沿其环形切开十二指肠的浆肌层。环形浆膜切开术后，通过内镜注入气体使黏膜下层扩张，目标病变充分抬起。在确认内镜通过无问题后，将包括目标病变在内的黏膜下层用吻合器切除。连续缝合浆肌层以掩埋并加固吻合器缝线。其中1例采用单孔腹腔镜手术。切除标本大小分别为52×32mm和50×26mm，手术切缘阴性。两名患者均无并发症出院，且无狭窄迹象。
与先前报道的手术方法相比，这种用于浅表性非壶腹十二指肠上皮肿瘤的十二指肠部分切除术加浆膜切开术的方法前景良好、操作简单且安全。
