Park S W, Song S Y, Chung J B, Lee S K, Moon Y M, Kang J K, Park I S
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2000 Apr;41(2):213-8. doi: 10.3349/ymj.2000.41.2.213.
Though surgical resection has been the traditional treatment for tumors of the ampulla of Vater, endoscopic maneuvers such as snare resection, laser photodestruction and electrofulguration have recently been introduced to avoid operation-related morbidity and mortality. From 1994 to 1996, 6 patients with ampullary tumor were managed by endoscopic snare resection and regularly followed. Endoscopic snare resection of the ampullary tumor was technically feasible in all patients and each procedure was performed in a single session. Histologic diagnoses of the resected specimens were adenoma in 4 patients and adenoma with coexistent adenocarcinoma in 2 patients. Resection margins were negative in all patients except 1 with coexistent adenocarcinoma and a radical pancreaticoduodenectomy was performed in that case. For the other patient with adenocarcinoma foci, no further treatment was persued since he was 72-year-old and refused operation. Acute pancreatitis developed in 2 patients after endoscopic therapy, but was resolved with conservative management. There was no procedure-related death. Surveillance duodenoscopy performed at 1 and 6 months after endoscopic resection revealed no evidence of recurrent tumor in 4 patients with adenoma. Among them, 3 patients are alive without evidence of recurrence at 16-37 months after resection, but 1 patient was lost after 9 months of follow-up. The patient with adenocarcinoma in whom a pancreaticoduodenectomy was performed, has been alive without recurrence for 12 months. Oral 5-fluorouracil was administered for the other patient with adenocarcinoma foci. Though he experienced local recurrence at 13 months after the procedure, he has been alive for 28 months after resection. In conclusion, endoscopic snare resection may be applied as a viable alternative to surgery in selected patients with small ampullary tumors.
虽然手术切除一直是 Vater 壶腹肿瘤的传统治疗方法，但最近已引入诸如圈套切除术、激光光凝和电灼等内镜操作，以避免与手术相关的发病和死亡。1994 年至 1996 年，6 例壶腹肿瘤患者接受了内镜圈套切除术并定期随访。内镜圈套切除壶腹肿瘤在所有患者中技术上都是可行的，且每个手术均在一次操作中完成。切除标本的组织学诊断为 4 例腺瘤，2 例腺瘤合并腺癌。除 1 例合并腺癌的患者外，所有患者的切除边缘均为阴性，该病例进行了根治性胰十二指肠切除术。对于另 1 例有腺癌灶的患者，由于其 72 岁且拒绝手术，未进行进一步治疗。2 例患者在内镜治疗后发生急性胰腺炎，但经保守治疗后缓解。无手术相关死亡。内镜切除术后 1 个月和 6 个月进行的十二指肠镜监测显示，4 例腺瘤患者无肿瘤复发迹象。其中，3 例患者在切除后 16 - 37 个月存活且无复发迹象，但 1 例患者在随访 9 个月后失访。接受胰十二指肠切除术的腺癌患者已存活 12 个月且无复发。对另 1 例有腺癌灶的患者给予口服 5 - 氟尿嘧啶。虽然他在术后 13 个月出现局部复发，但切除后已存活 28 个月。总之，内镜圈套切除术可作为部分小壶腹肿瘤患者可行的手术替代方法。
