在食道内镜下粘膜解剖后延迟的十二指肠 perforation 由穿孔复杂:一个案例报告
Shinya Nakatani1, Sayaka Mizuno1, Takahiro Fuji1
1Department of Medicine Division of Gastroenterology, Showa Medical University School of Medicine Tokyo Japan.
DEN open
|January 23, 2026
概括
在内镜下粘膜切割 (ESD) 后的延迟胃肠道穿孔是罕见的. 这一案例突出了十二指甲孔穿孔后食道ESD,表明预防性质子抑制剂 (PPI) 治疗可能有利于高风险患者.
科学领域:
- 胃肠病学 胃肠病学
- 内視鏡外科手術 內視鏡外科手術
- 胃肠道并发症 胃肠道并发症
背景情况:
- 内镜下粘膜切割 (ESD) 是表面食道瘤的标准治疗方法,已知并发症包括出血和穿孔.
- 远离ESD部位的延迟胃肠道穿孔是一种不常见但严重的并发症.
- 该患者有非类固醇抗炎药物 (NSAID) 相关的十二指肠和Helicobacter pylori感染史.
研究的目的:
- 报告一例罕见的食道ESD后延迟十二指肠穿孔的罕见病例.
- 讨论潜在的促成因素和对程序后管理的影响.
主要方法:
- 一名因食道状细胞癌而接受ESD的患者的病例报告.
- 治疗包括食道穿孔的手术内剪切,保守的治疗,以及随后的腹腔镜修复穿孔的十二指肠.
- 诊断成像包括计算机断层扫描 (CT) 和内镜.
主要成果:
- 在ESD期间发生了手术内食道穿孔,并以保守的方式进行管理.
- 术后6天,该患者在先前存在的痕部位出现了穿孔的十二指肠.
- laparoscopic omental patch修复成功,患者在恢复质子抑制剂 (PPI) 治疗后康复.
结论:
- 与压力相关的粘膜疾病可能导致了这位患者的十二指甲孔穿孔.
- 对于患有风险因素的患者,如有胃病史或ESD后手术内穿孔等,可以考虑预防性PPI治疗.
- 目前的指导方针缺乏关于在ESD后常规PPI使用的共识,特别是在iatrogenic穿孔后.
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