[壶腹腺瘤的治疗理念]
[Treatment concept of adenomas of Vater's ampulla].
作者信息
Witzigmann H, Möbius C, Uhlmann D, Geissler F, Tannapfel A, Halm U, Hauss J
机构信息
Klinik für Abdominal-, Transplantations- und Gefässchirurgie, Universität Leipzig.
出版信息
Chirurg. 2000 Feb;71(2):196-201. doi: 10.1007/s001040050033.
INTRODUCTION
The most common benign ampullary tumors are adenomas (80%). They are considered as premalignant lesions with a transformation rate to carcinoma of up to 30%.
METHODS
From 1 January 1997 to 28 February 1999 we treated 11 patients with adenoma of the ampulla of Vater. An ampullectomy was performed in 10 cases. One poor-risk patient could not be operated on.
RESULTS
No operative mortality occurred. In two patients a pT1 adenocarcinoma was diagnosed postoperatively. One of the two patients with a high-risk carcinoma underwent a second operation, a Whipple pancreatoduodenectomy. Nine of 10 patients had no recurrence with a median follow-up of 12 months.
CONCLUSION
One patient died of glioblastoma. We would therefore recommend ampullectomy as the first-line treatment for benign tumors of the ampulla of Vater. In low-risk pT1 carcinoma (G1/G2, L0) and R0 resection, local excision is acceptable. In high-risk pT1 carcinoma (G3 and/or L1) Whipple pancreatoduodenectomy is mandatory.
引言
最常见的壶腹良性肿瘤是腺瘤（占80%）。它们被视为癌前病变，癌变率高达30%。
方法
1997年1月1日至1999年2月28日，我们治疗了11例 Vater壶腹腺瘤患者。10例行壶腹切除术。1例高危患者无法进行手术。
结果
无手术死亡病例。2例患者术后诊断为pT1腺癌。其中1例高危癌患者接受了二次手术，即惠普尔胰十二指肠切除术。10例患者中有9例无复发，中位随访时间为12个月。
结论
1例患者死于胶质母细胞瘤。因此，我们建议将壶腹切除术作为 Vater壶腹良性肿瘤的一线治疗方法。对于低风险的pT1癌（G1/G2，L0）和R0切除，局部切除是可以接受的。对于高风险的pT1癌（G3和/或L1），惠普尔胰十二指肠切除术是必需的。
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