Rosen M, Zuccaro G, Brody F
Minimally Invasive Surgery Center, Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Building A-80, Cleveland OH 44195, USA.
Surg Endosc. 2003 Aug;17(8):1322-3. doi: 10.1007/s00464-002-4527-4. Epub 2003 Jun 13.
Adenomas of the duodenal papilla are rare lesions. Because of their malignant potential, resection is mandatory. Options for resection include endoscopic resection, transduodenal local excision, and pancreaticoduodenectomy. This report details a case of periampullary villous adenoma diagnosed endoscopically and resected laparoscopically via a transduodenal approach.
A healthy 75-year-old woman with heartburn underwent an upper endoscopy for vague right upper abdominal pain. A periampullary tumor was diagnosed. Endoscopic biopsy results were consistent with a villous adenoma, and endoscopic ultrasound showed distal bile duct involvement. The patient underwent laparoscopic transduodenal local excision of the tumor with biliary reconstruction.
Laparoscopic transduodenal resection of periampullary lesions provides advantages similar to those of an endoscopic resection by removal of the tumor using minimally invasive techniques. In addition, laparoscopic surgery maintains the surgical tenents of open transduodenal resection with en bloc tumor resection including the adjacent duodenal wall and ductal structures as necessary. As noted in this case, laparoscopic techniques resect ampullary lesions involving the ductal structures as well. Laparoscopic transduodenal ampullectomy is a valuable treatment option for benign and selected premalignant ampullary lesions.
十二指肠乳头腺瘤是罕见病变。因其具有恶变潜能，故必须进行切除。切除方式包括内镜切除、经十二指肠局部切除和胰十二指肠切除术。本报告详细介绍了一例经内镜诊断并通过经十二指肠途径腹腔镜切除的壶腹周围绒毛状腺瘤病例。
一名75岁健康女性，有烧心症状，因右上腹隐痛接受了上消化道内镜检查。诊断为壶腹周围肿瘤。内镜活检结果与绒毛状腺瘤一致，内镜超声显示远端胆管受累。患者接受了腹腔镜经十二指肠肿瘤局部切除及胆管重建术。
腹腔镜经十二指肠切除壶腹周围病变具有与内镜切除相似的优势，即采用微创技术切除肿瘤。此外，腹腔镜手术保持了开放经十二指肠切除的手术原则，整块切除肿瘤，必要时包括相邻的十二指肠壁和导管结构。如本病例所示，腹腔镜技术也可切除累及导管结构的壶腹病变。腹腔镜经十二指肠壶腹切除术是治疗良性和部分癌前壶腹病变的一种有价值的选择。
