Wang Feng-Lan, Tang Xiao-Xuan, Wu Rui, Gao Yu-Jia, Liu Yi-Ran, Wang Lei, Zou Xiao-Ping, Zhang Bin
Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China.
Department of Gastroenterology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China.
World J Gastrointest Surg. 2025 Jun 27;17(6):106637. doi: 10.4240/wjgs.v17.i6.106637.
Endoscopic papillectomy (EP) endoscopic retrograde cholangiopancreatography has emerged as a less invasive alternative to surgery for duodenal papillary adenomas (DPAs), which is traditionally associated with notable postoperative risks.
To compare quality of life (QoL) and outcomes between DPA patients undergoing EP surgical resection, and to assess the influencing factors of QoL and complications.
We conducted a retrospective, single-center analysis involving patients treated for DPA at the Drum Tower Hospital of Nanjing University Medical School from 2011 to 2023. The participants completed post-discharge telephone surveys using the 12-item short form survey to assess mental (MCS) and physical component summary (PCS) scores, with norm-based scoring where ≥ 50 denotes normal. Multivariate regression analysis adjusted for confounding variables was used to compare QoL scores.
Compared with EP patients, surgically treated patients had significantly lower PCS [median: 53.0, interquartile range (IQR): 46.0-55.1 54.2, IQR: 51.7-55.9, = 0.008] and MCS scores (median: 48.6, IQR: 41.8-56.0 55.9, IQR: 51.7-60.7, < 0.001). These disparities persisted even after adjustments for demographic and medical factors. Long-term follow-up of the EP group revealed that abdominal pain and poor sleep were factors negatively impacting PCS scores, whereas postoperative pancreatitis and hypertension were associated with lower MCS scores.
EP has emerged as a QoL-preserving alternative for patients with DPA, conditional upon ensuring equivalent efficacy and safety. QoL outcomes should be considered when choosing interventions for this patient population.
内镜下乳头切除术（EP）和内镜逆行胰胆管造影术已成为十二指肠乳头腺瘤（DPA）手术的一种侵入性较小的替代方法，传统手术术后风险较高。
比较接受EP和手术切除的DPA患者的生活质量（QoL）和结局，并评估QoL和并发症的影响因素。
我们进行了一项回顾性单中心分析，纳入了2011年至2023年在南京大学医学院附属鼓楼医院接受DPA治疗的患者。参与者在出院后通过电话调查完成了12项简短调查问卷，以评估心理（MCS）和身体成分总结（PCS）得分，基于常模评分，≥50分表示正常。采用多变量回归分析对混杂变量进行调整，以比较QoL得分。
与EP患者相比，手术治疗患者的PCS得分显著更低[中位数：53.0，四分位数间距（IQR）：46.0 - 55.1 vs 54.2，IQR：51.7 - 55.9，P = 0.008]，MCS得分也显著更低（中位数：48.6，IQR：41.8 - 56.0 vs 55.9，IQR：51.7 - 60.7，P < 0.001）。即使在对人口统计学和医学因素进行调整后，这些差异仍然存在。对EP组的长期随访显示，腹痛和睡眠不佳是对PCS得分产生负面影响的因素，而术后胰腺炎和高血压与较低的MCS得分相关。
在确保等效疗效和安全性的前提下，EP已成为DPA患者保留QoL的替代方法。为该患者群体选择干预措施时应考虑QoL结局。
