Jeanniard-Malet Odile, Caillol Fabrice, Pesenti Christian, Bories Erwan, Monges Geneviève, Giovannini Marc
Department of Oncological Medico-surgical Investigations, Institut Paoli-Calmettes, Marseille, France.
Scand J Gastroenterol. 2011 Jul;46(7-8):1014-9. doi: 10.3109/00365521.2011.571711. Epub 2011 Apr 15.
Benign lesions of the major papilla are rare but raise the problem of their medical care. We studied the efficacy, safety, and histology of the endoscopic ampullectomy.
Forty-two endoscopic resections of the major papilla were undertaken in 23 males and 19 females of a mean age of 63. Five patients (12%) presented with a familial adenomatous polyposis. The assessment of resectability included preoperative histology, and endoscopic ultrasound (EUS) in 26 patients (62%) always showing intra-mucosal lesion. The resection was performed with a duodenoscope, using a diathermic loop with a pure current section.
The resection was realized in one piece for 34 patients, in 2-4 fragments for 8 patients. A plastic pancreatic stent was inserted in 26 patients (62%), a plastic biliary stent in 10 patients (24%). There were no deaths but nine complications (21%): six acute pancreatitis (four patients with a pancreatic stent, contrary to the literature), three delayed gastrointestinal bleeding. The final histological result was fibrosis and inflammatory tissue in 7 patients, low-grade dysplasia in 20 patients, high-grade dysplasia or in situ carcinoma in 10 patients, invasive adenocarcinoma in 1 patient, and somatostatinoma in 2 patients (concordance of 72% with the initial histology). The resection was complete in 39 patients (93%). Three patients had additional surgery because of positive margin of resection or bad histology criteria. The median of follow-up in 33 patients with a complete resection was of 15 months, and we did not note any recurrence in 29 patients (88%).
Endoscopic ampullectomy is an efficient treatment for superficial lesions of the papilla, despite a significant but rarely severe morbidity. Preoperative EUS is mandatory, preoperative histology is advisable. Long-term follow-up is necessary.
主乳头良性病变罕见，但引发了其医疗护理问题。我们研究了内镜下壶腹切除术的疗效、安全性及组织学情况。
对23名男性和19名女性进行了42例主乳头内镜切除术，平均年龄63岁。5例患者（12%）患有家族性腺瘤性息肉病。可切除性评估包括术前组织学检查，26例患者（62%）进行了内镜超声（EUS）检查，均显示为黏膜内病变。使用十二指肠镜，通过带有纯电流切割的电热圈套器进行切除。
34例患者一次性完整切除，8例患者分2 - 4块切除。26例患者（62%）插入了塑料胰管支架，10例患者（24%）插入了塑料胆管支架。无死亡病例，但有9例并发症（21%）：6例急性胰腺炎（4例患者放置了胰管支架，与文献报道相反），3例延迟性胃肠道出血。最终组织学结果为7例患者为纤维化和炎性组织，20例患者为低级别异型增生，10例患者为高级别异型增生或原位癌，1例患者为浸润性腺癌，2例患者为生长抑素瘤（与初始组织学的符合率为72%）。39例患者（93%）切除完整。3例患者因切除边缘阳性或组织学标准不佳而接受了额外手术。33例完整切除患者的中位随访时间为15个月，29例患者（88%）未发现复发。
内镜下壶腹切除术是治疗乳头浅表病变的有效方法，尽管发病率较高，但很少严重。术前EUS是必需的，术前组织学检查也可取。长期随访是必要的。
