Department of Gastroenterology, Sendai City Medical Center, Sendai, Miyagi, Japan.
Dig Endosc. 2011 Apr;23(2):113-7. doi: 10.1111/j.1443-1661.2010.01101.x. Epub 2011 Feb 9.
For ampullary cancer, pancreaticoduodenectomy is considered to be the standard treatment. Endoscopic papillectomy (EP) has been utilized in cases of ampullary adenoma since the early 1980s. We aimed to provide a review concerning EP.
We conducted a review of studies regarding EP for ampullary neoplasms.
Since neither lymphatic permeation, vascular invasion, nor lymph node metastasis is observed in patients with ampullary cancer limited to the mucosa, EP of such tumors without ductal infiltration into the pancreatic/bile duct can be justified as radical treatment. For its application in patients with ampullary neoplasms, accurate pretreatment staging is indispensable. EUS, which can be carried out on an outpatient basis with a low risk of complications, is useful for differential diagnosis as well as detection of periampullary tumors. Although intraductal US of the bile duct tends to result in overestimation of tumor staging in cases of ampullary neoplasm, it can provide useful information for making therapeutic decisions, especially in cases appropriate for EP. While the technical success rate of EP is high, the complication rate and recurrence rate are not as low as a satisfactory level. Pancreatic duct stenting after EP is expected to contribute to prevention of post-EP pancreatitis. There is no consensus regarding the mode of resection current nor the need for addition of biliary/pancreatic sphincterotomy and biliary stenting.
EP has been reported to be useful in selected patients with ampullary neoplasms. Data on further long-term follow up after EP are awaited.
对于壶腹癌，胰十二指肠切除术被认为是标准治疗方法。自 20 世纪 80 年代初以来，内镜乳头切除术（EP）已用于壶腹腺瘤病例。我们旨在对 EP 进行综述。
我们对有关 EP 治疗壶腹肿瘤的研究进行了回顾。
由于局限于黏膜的壶腹癌患者没有淋巴管渗透、血管侵犯或淋巴结转移，因此没有胰管/胆管浸润的此类肿瘤的 EP 可以被认为是根治性治疗。对于其在壶腹肿瘤患者中的应用，准确的术前分期是必不可少的。EUS 可以在门诊进行，具有低并发症风险，对于鉴别诊断以及检测壶腹周围肿瘤非常有用。虽然胆管内超声检查在壶腹肿瘤病例中往往会高估肿瘤分期，但它可以为治疗决策提供有用的信息，尤其是对于适合 EP 的病例。虽然 EP 的技术成功率很高，但并发症率和复发率并不理想。EP 后进行胰管支架置入有望有助于预防 EP 后胰腺炎。目前对于切除方式和是否需要添加胆胰括约肌切开术和胆道支架置入术尚无共识。
EP 已被报道对某些壶腹肿瘤患者有用。需要等待进一步的 EP 后长期随访数据。
