经内镜十二指肠乳头切除术治疗乳头部肿瘤的临床价值  

Endoscopic papillectomy for tumors at ampulla of Vater

作　　者：覃华[1] 赵秋[1] 李德民[1] 王波[1] 李荣香[1] 张敏[1] 胡继芬[1] 王渝[2] 

机构地区：[1]华中科技大学同济医学院附属同济医院消化内科,武汉430030 [2]华中科技大学同济医学院附属同济医院病理科,武汉430030

出　　处：《中华消化内镜杂志》2012年第8期437-440,共4页Chinese Journal of Digestive Endoscopy

基　　金：教育部高等学校博士学科点专项科研基金（20110142110013）

摘　　要：目的探讨经内镜十二指肠乳头切除术（EP）治疗十二指肠乳头部肿瘤的临床价值。方法前瞻性观察研究15例经EP治疗的十二指肠乳头部肿瘤患者的临床疗效、并发症及随访观察结果，评价其临床价值。结果所有15例患者均顺利完成EP治疗，其中4例术前病检为慢性炎症者术后病理诊断为腺瘤；11例术前病检为腺瘤者中术后病理诊断为高分化腺癌1例、低分化腺癌2例、腺瘤恶变1例。EP术后8例合并胰胆管扩张者同时行胆管及胰管塑料支架引流术，1例确诊为低分化腺癌者、1例确诊为腺瘤恶变者及1例腺瘤部分残留者术后追加外科手术治疗，另1例低分化腺癌者因年龄较大拒绝追加手术治疗。EP术后除2例患者出现黑便，2例患者出现一过性血淀粉酶升高外，无急性胰腺炎、胆管炎及穿孔等并发症发生，无患者死亡。EP术后平均随访观察23．4个月，11例（11／15，73．3％）病变完整切除者中，10例腺瘤者均未见复发，另1例乳头部高分化腺癌者术后已随访5个月，多次复查病检均未见复发。结论EP术不仅可提高十二指肠乳头部肿瘤诊断的准确率；对于十二指肠乳头部腺瘤，EP术可将腺瘤组织完整切除达到根治的目的，是一项安全、有效的微创治疗措施。Objective To assess the feasibility, safety and efficacy of endoscopic papillectomy （EP） for tumors at the ampulla of Vater （AV）. Methods A total of 15 patients with tumor at AV that were indicated for EP were included in this prospective study. Their clinical profiles, procedural parameters and outcome were evaluated. Results All patients underwent EP procedure successfully. Four patients who were diagnosed as having chronic inflammation in the reference endoscopy were confirmed as having adenoma after EP. Out of the 11 patients who were previously diagnosed as andenoma on biopsy, 2 of low differentia- ted adenoearcinoma, 1 of well differentiated adenocarcinoma and 1 malignant transformation were pathologi- cally confirmed after EP. Stents were implanted in 8 patients with dilated pancreatic and/or common bile duct. Except for 2 cases of melena and 2 transient elevated level of blood amylase after EP, no other major complications occurred. Three patients, including 1 case of low-differentiated adenocarcinoma, 1 case of ma- lignant transformation and 1 case of lesion residual, were referred to surgery, another patient with low-differ- entiated adenoeareinoma declined any additional intervention because of old age. In the remaining 11 cases （11/15, 73. 3% ） including one well differentiated adenocarcinoma, no recurrence was observed during a follow-up period of 23.4 （5 to 47） months. Conclusion EP is a minimal invasive, safe and effective treat- ment for tumors at AV, which also can provide an accurate staging of the lesion.

关 键 词：肝胰管壶腹 腺瘤 治疗 微创性 

分 类 号：R735.3[医药卫生—肿瘤]