Contini S, Zinicola R, Bonati L, Caruana P
Department of General Surgery and Organ Transplantation, University of Parma, Parma, Italy.
Minerva Chir. 2003 Jun;58(3):405-8.
We report a patient in whom heterotopic pancreatic tissue was found within the ampulla and treated by ampullectomy. Only 16 cases of pancreatic tissue located at the ampulla of Vater have been reported in the literature and pancreaticoduodenectomy has been performed in more than half the cases because malignancy was suspected preoperatively, reflecting a rather aggressive surgical attitude. An accurate preoperative evaluation thus appears decisive to avoid unnecessary radical surgery. Endoscopic treatment of ampullary tumors is emerging as a viable alternative to surgical treatment. Local surgical excision is a reasonable option to endoscopic treatment. The possibility of heterotopic pancreatic tissue, though rare, should be included in the differential diagnosis of papillary tumors. Histologic confirmation (frozen or delayed) is mandatory before attempting such major surgery.
我们报告了一名在壶腹内发现异位胰腺组织并接受壶腹切除术治疗的患者。文献中仅报道了16例位于Vater壶腹的胰腺组织病例，由于术前怀疑有恶性肿瘤，超过半数的病例进行了胰十二指肠切除术，这反映出一种较为激进的手术态度。因此，准确的术前评估对于避免不必要的根治性手术似乎至关重要。壶腹肿瘤的内镜治疗正在成为手术治疗的一种可行替代方案。局部手术切除是内镜治疗的一个合理选择。异位胰腺组织的可能性虽然罕见，但在乳头状肿瘤的鉴别诊断中应予以考虑。在尝试进行此类大手术之前，必须进行组织学确认（冰冻或延迟）。
