背景:对于一些非壶腹十二指肠肿瘤,局部十二指肠切除术和一期闭合是一种简单的选择。在确保可固化性的同时最小化切除面积对于安全的原发性十二指肠闭合是必要的。然而,通常很难从浆膜侧确定合适的切除线。我们开发了夹子引导的局部十二指肠切除术,以轻松确定切除范围并安全地进行局部十二指肠切除术,然后进行了一项回顾性观察性研究,以确认夹子引导下局部十二指肠切除术的安全性.
方法:程序如下:在手术前3天内将内窥镜金属夹放在肿瘤周围边缘的四个点上,在手术期间用X射线成像的夹子识别肿瘤范围,在通过X射线成像可视化的夹子外面切开十二指肠,用夹子作为肿瘤分界指导的十二指肠全层切除术,并通过Gambee缝合横向闭合。我们评估了2010年1月至2020年5月在两个手术中心接受夹子引导局部十二指肠切除术的患者的临床病理数据和手术结果。
结果:纳入18例患者。病理诊断为腺瘤(11例),腺癌(6例),和GIST(1例)。平均±SD肿瘤大小为18±6mm,肿瘤主要位于十二指肠的第二部分(66%)。在所有情况下,十二指肠缺损用初级缝线闭合。平均手术时间和出血量分别为191min和79mL,分别。发病率为22%,所有并发症均为Clavien-DindoII级。未观察到吻合口漏或狭窄。在6例腺癌患者中,都被诊断为pT1a,未观察到术后复发。1年总生存率和无复发生存率为100%。
结论:对于十二指肠腺瘤等非壶腹十二指肠肿瘤的微创局部切除,夹式引导下局部十二指肠切除术是一种安全有效的手术选择。GIST,和早期腺癌。
BACKGROUND: Local duodenectomy and primary closure is a simple option for some nonampullary duodenal neoplasms. Minimizing the resection area while ensuring curability is necessary for safe primary duodenal closure. However, it is often difficult to determine the appropriate resection line from the serosal side. We developed clip-guided local duodenectomy to easily determine the resection range and perform local duodenectomy safely, then performed a retrospective observational study to confirm the safety of clip-guided local duodenectomy.
METHODS: The procedure is as follows: placing endoscopic metal clips at four points on the margin around the tumor within 3 days before surgery, identifying the tumor extent with the clips under X-ray imaging during surgery, making an incision to the duodenum just outside of the clips visualized by X-ray imaging, full-thickness resection of the duodenum with the clips as guides of tumor demarcation, and transversely closure by Gambee suture. We evaluated clinicopathological data and surgical outcomes of patients who underwent clip-guided local duodenectomy at two surgical centers between January 2010 and May 2020.
RESULTS: Eighteen patients were included. The pathological diagnosis was adenoma (11 cases), adenocarcinoma (6 cases), and GIST (1 case). The mean ± SD tumor size was 18 ± 6 mm, and the tumor was mainly located in the second portion of the duodenum (66%). In all cases, the duodenal defect was closed with primary sutures. The mean operation time and blood loss were 191 min and 79 mL, respectively. The morbidity was 22%, and all complications were Clavien-Dindo grade II. No anastomotic leakage or stenosis was observed. In the 6 adenocarcinoma patients, all were diagnosed with pT1a, and postoperative recurrence was not observed. The 1-year overall and recurrence free survival rate was 100%.
CONCLUSIONS: Clip-guided local duodenectomy is a safe and useful surgical option for minimally local resection of nonampullary duodenal neoplasms such as duodenal adenoma, GIST, and early adenocarcinoma.