| Objective:Duodenal papilla locates in the posteromedial wall of the middle of duodenal dsscending period and it is the common opening of the common bile duct and pancreatic duct in duodenum.Its anatomical location is very spetial.Pancreaticoduodenectomy is the common surgery in the treatment of duodenal papillary carcinoma. Surgical procedures are complex,high risk with large trauma and high mortality.With the development of gastrointestinal endoscopic techniques, endoscopic papillectomy(EP) has gradually applied to the treatment of papilla precancerous leisions and early cancer.This study aims to evaluate the diagnostic and clinical application value of EP in the papilla lesions.Methods:This is a retrospective study.In order to analyse the indication,clinical therapeutic effects,postoperative complications and prognosis of endoscopic resection for duodenal papillary leisions,we collected the clinical and pathological data of 15 EPs in Shandong Provencial Hospital from Novenber 2010 to March 2016.Results:The study collected 15 cases of duodenal papillary leisions,including 9 (60%) males,6 (40%) females,aged from 44 to 79 years old.3 (20%) cases were foungded by gastroscopy,7 (46.6%) cases complicated with jaundice,2 (13.3%) cases with abdominal pain and abdominal distention,l (6.7%) case with fever,1 (6.7%) case with acute pancreatitis,1 (6.7%) case complicated with acute pancreatitis and obstructive jaundice.The 15 cases were all successfully completed by EP.3 cases of speciment were lost due to falling into the intestinal tract and failed to take out.The rest 12 cases1 postoperative pathology showed thatl (8.3%) case was adenoma,2(16.7%) cases were adenomas with light to moderate atypical hyperplasia,1(8.3%) case was adenoma with moderate to severe atypical hyperplasia.3 (20%) case was chronic inflammation (1 of the 3 cases was local suspicious carcinoma),5 (41.7%) cases were adenocarcinoma(one of the 4 cases performed the pancreaticoduodenectomy and chemotherapy after EP,1 case as surgical excision was unlikely to be completed and the prognosis was not good,the patient was treated by EP in digestive system department).After EP,8 (53.3%) cases had no obvious discomfort,1 (6.7%) case with perforation,1(6.7%) case with abdominal pain and abdominal distention,2 (13.3%) cases with hematemesis,2 (13.3%) case with abdominal pain and fever,1 (6.7%) case with acute pancreatitis.All these physical symptoms achieved remission by conservative treatment such as anti-inflammation,anti-enzyme,hemostasis,acid suppression and liver-protecting.12 cases were successfully followed up after EP.The time ranged from 1 months to 60 months as an average of 12 months.5 cases were followed up by telephone as they didn’t get endoscopic examination.2 cases choose surgical treatment.1 case reviewed endoscopy after 3 months of EP.The endoscopy was normal.2 cases of adenocarcinoma regularly reviewed endoscopy and there was no obvious abnormal.1 case died as tumor recurrence 1 year later after EP.l case had bile duct stone again 1 year later after EP and considered the operative site had suspected malignance.The patient proceeded ERCP+biliary stent placement..Conclusion:Endoscopic Papillectomy is safe and feasible for duodenal papillary leisions.lt can treat precancerous leisions and early cancer lesions of duodenal papilla,so as to avoid surgical treatment.At the same time it has a certain guiding significance by providing pathological basis for surgical operation. |
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