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目的总结内镜治疗十二指肠乳头肿瘤的经验,探讨其临床价值及并发症防治策略。方法回顾性分析2010年1月至2017年5月复旦大学附属中山医院内镜中心行内镜十二指肠乳头肿瘤切除术的36例病人临床资料。结果 36例病人共行38例次手术,均顺利完成手术。29例次未夹闭创面手术,其中1例次(3.4%)发生穿孔,5例次(17.2%)出现迟发性出血,3例次(10.3%)发生胰腺炎,2例次(6.9%)发生胆管炎,1例次(3.4%)出现影响胆汁和胰液排出的术后狭窄。9例次行留置胰、胆管支架后夹闭创面手术,未发生出血、穿孔及胰腺炎,其中1例次(11.1%)发生胆囊炎,1例次(11.1%)出现影响胆汁和胰液排出的术后狭窄。随访时间30.5(1.0~85.0)个月,2例病人出现复发,予以内镜下再次切除处理。结论内镜十二指肠乳头肿瘤切除术治疗十二指肠乳头肿瘤可能有效,但术后并发症发生率较高,需重点关注。术后留置胰、胆管支架后夹闭创面可能会降低并发症发生率。
Objective To summarize the experience of endoscopic treatment of duodenal papillary tumors and to explore its clinical value and prevention and treatment strategies. Methods The clinical data of 36 patients undergoing endoscopic papillary duodenal tumor resection from Zhongshan Hospital of Fudan University from January 2010 to May 2017 were retrospectively analyzed. Results Thirty-six patients underwent a total of 38 secondary surgeries, all of whom successfully completed the operation. There were 29 cases of non-occluded wound surgery, of which 1 case (3.4%) had perforation, 5 cases (17.2%) had delayed bleeding, 3 cases (10.3%) had pancreatitis, 2 cases (6.9% ) Cholangitis occurred, and 1 case (3.4%) had postoperative stenosis that affected the excretion of bile and pancreatic juice. Of the 9 cases, bleeding, perforation and pancreatitis were not occured after 9 cases of pancreatic or biliary stents were occluded. One case (11.1%) had cholecystitis and one case (11.1%) had biliary and pancreatic effusions Postoperative stenosis. Follow-up time was 30.5 (1.0-85.0) months. Two patients developed recurrence and were treated by endoscopic resection. Conclusions Endoscopic duodenal papilla resection for the treatment of duodenal papillary tumors may be effective, but the incidence of postoperative complications is higher, which needs attention. Postoperative retention of pancreatic, biliary stent clipping the wound may reduce the incidence of complications.