内镜十二指肠乳头切除术的疗效、安全性和技术要点探讨
| 作 者：张勇, 杜超, 庞勇, 王玲, 杨明, 陈出新, 汤善宏 |
| 单 位：中国人民解放军西部战区总院 |
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| 摘 要： |
| 背景：十二指肠乳头肿瘤的检出率呈上升趋势。与传统胰十二指肠切除术相比，内镜十二指肠乳头切除术（EP）优势显著，已成为十二指肠壶腹部良性肿瘤的一线治疗手段。目的：观察EP对十二指肠乳头肿瘤的临床疗效和安全性，并探讨其关键技术要点。方法：回顾性分析2021年1月—2024年12月于西部战区总医院接受EP的25例十二指肠乳头肿瘤患者的临床资料，总结手术过程、术后并发症和随访结果。结果：25例患者均顺利完成EP。20例患者行乳头开口肛侧病变黏膜下注射；19例整块切除，3例分块切除；18例置入胆管、胰管双支架，5例仅置入胆管支架，1例仅置入胰管支架；所有患者均以金属夹封闭创面。术后3例患者发生轻度胰腺炎、6例高淀粉酶血症，均经保守治疗后缓解；所有患者均未发生迟发性出血、穿孔。随访期间（平均25.6个月），1例胆管狭窄伴胆管炎患者经覆膜金属支架置入后缓解；4例残留或复发（2例再行内镜切除、1例行氩离子凝固术、1例行胰十二指肠切除）；无患者死亡。结论：EP具有安全、有效、微创的优势，但存在一定复发率。术前应完善相关检查、严格把握适应证；术中对乳头开口肛侧病灶行黏膜下注射，术后常规留置胆管、胰管支架并以金属夹封闭创面，可降低胰腺炎、迟发性出血、穿孔等并发症风险，改善患者预后。 |
| 关键词：内镜十二指肠乳头切除术；十二指肠乳头肿瘤；治疗；安全 |
Discussion on Efficacy, Safety and Technical Key Points of Endoscopic Papillectomy
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| Abstract: |
| Background: The detection rate of duodenal papillary tumors is on the rise. Compared with traditional pancreaticoduodenectomy, endoscopic papillectomy (EP) has significant advantages and has become the first-line treatment for benign tumors of the duodenal ampulla. Aims: To evaluate the clinical efficacy and safety of EP for duodenal papillary tumors and to explore its key technical points. Methods: The clinical data of 25 patients with duodenal papillary tumors who underwent EP at General Hospital of Western Theater Command from January 2021 to December 2024 were retrospectively analyzed. The surgical procedures, postoperative complications, and follow-up outcomes were summarized. Results: All 25 patients successfully completed EP. Submucosal injection was performed for lesions on the anal side of the papillary orifice in 20 patients; en bloc resection was achieved in 19 patients and piecemeal resection in 3; dual biliary and pancreatic stents were placed in 18 patients, biliary stent alone in 5, and pancreatic stent alone in 1; all patients underwent wound closure with metal clips. Postoperatively, 3 patients developed mild pancreatitis and 6 developed hyperamylasemia, all of which resolved with conservative treatment; no patient developed delayed bleeding or perforation. During follow-up (mean 25.6 months), 1 case of biliary stricture with cholangitis resolved after placement of a covered metal stent; 4 cases had residual or recurrent lesions (2 underwent repeat endoscopic resection, 1 received argon plasma coagulation, and 1 underwent pancreaticoduodenectomy); no patient died. Conclusions: EP is safe, effective, and minimally invasive, but carries a certain recurrence rate. Preoperatively, relevant examinations should be completed and indications should be strictly controlled; intraoperatively, submucosal injection should be performed for lesions on the anal side of the papillary orifice, and postoperatively, biliary and pancreatic stents should be routinely placed with metal clip closure of the wound, which can reduce the risk of pancreatitis, delayed bleeding, and perforation, and improve patient prognosis. |
| Keywords: Endoscopic Papillectomy; Duodenal Papillary Neoplasms; Therapy; Safety |
| 投稿时间：2026-04-23 |
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