Bohnacker S, Soehendra N, Maguchi H, Chung J B, Howell D A
Department for Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Endoscopy. 2006 May;38(5):521-5. doi: 10.1055/s-2006-925263.
Most benign papillary tumors are adenomas which can potentially undergo the adenoma-carcinoma-sequence making complete removal mandatory for curative therapy. Endoscopic resection (papillectomy) of these lesions is being increasingly performed as a less traumatic alternative to surgery. Available data shows endoscopic papillectomy to be effective and safe in experienced hands with usually little morbidity and virtually no mortality. Success rates are around 80 % for lesions without intraductal involvement. Selected cases of limited distal intraductal involvement accessible after sphincterotomy may also be managed curatively by endoscopic resection. Endoscopic snare resection of entire lesions should be primarily regarded as a diagnostic procedure. It allows for an accurate histological diagnosis based on examination of the entire specimen rather than forceps biopsies and thus a reliable assessment of the need for surgical therapy. Subsequent surgery in operable patients is not precluded by previous endoscopic resection. Surgery is indicated in case of incomplete removal and if malignancy is present. The curative role of endoscopic papillectomy for early invasive carcinoma needs to be established. Histological features and individual risk for surgery are factors to be considered. Inoperable patients may still benefit from palliative endoscopic stenting. After endoscopic papillectomy has been completed, regular follow-up examinations including biopsies are warranted because of the risk of local recurrence. For benign looking papillary tumors, endoscopic papillectomy serves as a diagnostic tool and should be considered as first line procedure regardless of age. The following article details the approach to patients with benign papillary tumor and the technique of endoscopic papillectomy.
大多数良性乳头状肿瘤是腺瘤，有可能经历腺瘤-癌序列演变，因此根治性治疗必须将其完整切除。这些病变的内镜下切除（乳头切除术）作为一种创伤较小的手术替代方法，应用越来越广泛。现有数据表明，在内镜操作熟练者手中，内镜乳头切除术有效且安全，通常并发症少，几乎无死亡率。对于无导管内累及的病变，成功率约为80%。括约肌切开术后可触及的远端导管内累及范围有限的部分病例，也可通过内镜切除进行根治性治疗。内镜圈套器完整切除病变应主要视为一种诊断性操作。它能基于对整个标本的检查进行准确的组织学诊断，而不是钳取活检，从而可靠地评估是否需要手术治疗。可手术患者先前的内镜切除并不排除后续手术。切除不完全及存在恶性肿瘤时需行手术治疗。内镜乳头切除术对早期浸润癌的根治作用有待确立。组织学特征和个体手术风险是需要考虑的因素。无法手术的患者仍可能从姑息性内镜支架置入中获益。内镜乳头切除术后，由于存在局部复发风险，需要进行包括活检在内的定期随访检查。对于外观良性的乳头状肿瘤来说，内镜乳头切除术是一种诊断工具，无论年龄大小，都应被视为一线治疗方法。以下文章详细介绍了良性乳头状肿瘤患者的治疗方法及内镜乳头切除术的技术。
