壶腹部肿瘤的诊断与局部切除  

Diagnosis and local resection of ampullary tumors

作　　者：陈冬[1] 朱峰[1] 王敏[1] 田锐[1] 秦仁义[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院胆胰外科,湖北省武汉市430030

出　　处：《世界华人消化杂志》2013年第36期4185-4188,共4页World Chinese Journal of Digestology

基　　金：国家自然科学基金资助项目;Nos.81071775;81272659~~

摘　　要：目的:探讨壶腹部肿瘤的诊断及局部切除的安全性和疗效.方法:回顾性分析2011-01/2013-09我院收治的86例壶腹部肿瘤患者的临床病理资料.结果:86例患者中,83例胆胰管扩张,B超可见胆胰管扩张83例(83/83,100%),薄层CT扫描可见壶腹部肿块或者胆管壁强化80例(80/86,93.0%),M R C P可见胆胰管扩张或壶腹部肿块69例(69/86,80.2%),52例患者行超声内镜及穿刺活检,可见低回声肿块49例(49/52,94.2%),其中恶性肿瘤40例,穿刺提示恶性7例(7/40,17.5%),77例恶性肿瘤患者术中快速病检提示恶性72例(72/77,93.5%);十二指肠乳头局部切除+胆胰管成形术22例,其中良性9例(5例为高级别上皮内瘤变),局部恶性13例,术后无死亡病例及手术并发症,随访2-32 mo无复发.结论:薄层CT、MRCP及超声内镜具有重要的诊断作用,术中快速病检诊断肿瘤性质准确率高,但存在一定的假阴性;壶腹部肿瘤局部切除+胆胰管成形术是一种安全可靠的手术方式,创伤小,术后并发症及死亡率低,壶腹部良性肿瘤及局部恶变肿瘤局部切除后效果好,复发率低.AIM： To investigate the diagnosis and local re- section of ampullary tumors. METHODS： Clinical and pathological data for 86 patients with ampullary tumors treated at our hospital from January 2011 to September 2013 were retrospectively analyzed. RESULTS： Of the 86 patients, 83 had biliary and pancreatic duct dilation, and type-B ultra- sound could detect biliary and pancreatic duct dilation in all the 83 patients （100%）. Thin-slice CT detected an ampullary lump or gallbladder wall enhancement in 80 of 86 patients （93.0%）, while MRCP detected biliary and pancreatic duct dilation or an ampullary lump in 69 of 86 patients （80.2%）. Fifty-two cases underwent EUS （endoscopic ultrasonography） and biopsy, and alow echo mass was found in 49 cases （94.2%）, of which 40 were malignant tumors. Biopsy proved malignancy in 7 of the 40 patients （17.5%）. In- traoperafive rapid frozen section proved malig- nancy in 72/77 （93.5%） of patients. Twenty-two patients underwent local excision of ampullary tumors and pancreaticobiliary duct plasty, of whom 9 were confirmed with benign diseases （high grade intraepithelial neoplasia in 5） and 13 with local malignancies. There was no death or complication after surgery and no recurrence during 2 to 32 months of follow-up. CONCLUSION： Thin slice CT, MRCP and EUS are important tools for the diagnosis of ampul- lary tumors, while rapid intraoperative patho- logical examination has a high accuracy but with certain false negatives. Local excision of duode- nal papilla and pancreaticobiliary duct plasty are safe, with minor trauma, few complications and low recurrence rate, particularly for ampullary benign tumors and localized malignant tumors.

关 键 词：壶腹部肿瘤 诊断 局部切除 

分 类 号：R735.0[医药卫生—肿瘤]