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作 者:Darren L Scroggie Vasileios K Mavroeidis
机构地区:[1]Department of Population Health Sciences,Bristol Centre for Surgical Research,Bristol Medical School,Bristol BS82PS,United Kingdom [2]Department of HPB Surgery,University Hospitals Bristol and Weston NHS Foundation Trust,Bristol Royal Infirmary,Bristol BS28HW,United Kingdom [3]Department of Surgery,The Royal Marsden NHS Foundation Trust,London SW36JJ,United Kingdom
出 处:《World Journal of Gastrointestinal Surgery》2021年第11期1338-1350,共13页世界胃肠外科杂志(英文版)(电子版)
摘 要:Tumours of the ampulla of Vater are relatively uncommon lesions of the digestive system.They are typically diagnosed at an earlier stage than other types of tumours in this region,due to their tendency to invoke symptoms by obstructing the bile duct or pancreatic duct.Consequently,many are potentially curable by excision.Surgical ampullectomy(SA)(or transduodenal ampullectomy)for an ampullary tumour was first described in 1899,but was soon surpassed by pancreatoduodenectomy(PD),which offered a more extensive resection resulting in a lower risk of recurrence.Ongoing innovation in endoscopic techniques over recent decades has led to the popularization of endoscopic papillectomy(EP),particularly for adenomas and even early cancers.The vast majority of resectable ampullary tumours are now treated using either PD or EP.However,SA continues to play a role in specific circumstances.Many authors have suggested specific indications for SA based on their own data,practices,or interpretations of the literature.However,certain issues have attracted controversy,such as its use for early ampullary cancers.Consequently,there has been a lack of clarity regarding indications for SA,and no evidence-based consensus guidelines have been produced.All studies reporting SA have employed observational designs,and have been heterogeneous in their methodologies.Accordingly,characteristics of patients and their tumours have differed substantially across treatment groups.Therefore,meaningful comparisons of clinical outcomes between SA,PD and EP have been elusive.Nevertheless,it appears that suitably selected cases of ampullary tumours subjected to SA may benefit from favourable peri-operative and long-term outcomes with very low mortality and significantly long survival,hence its role in this setting warrants further clarification,while it can also be useful in the management of specific benign entities.Whilst the commissioning of a randomised controlled trial seems unlikely,well-designed observational studies incorporating adjustments for
关 键 词:Ampulla of Vater Ampullary tumours Surgical ampullectomy Transduodenal ampullectomy Endoscopic papillectomy PANCREATODUODENECTOMY
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