Masu Kaori, Ito Kei, Fujita Naotaka, Noda Yutaka, Kobayashi Go, Horaguchi Jun, Koshita Shinsuke, Katoh Yuhei, Yamashita Yasunobu, Kanno Yoshihide, Ogawa Takahisa, Sawai Takashi
Department of Gastroenterology, Sendai City Medical Center.
Nihon Shokakibyo Gakkai Zasshi. 2011 Sep;108(9):1546-53.
A 60's man underwent a medical check-up and esophagogastroduodenoscopy revealed an exposed-type tumor at the ampulla of Vater. Endoscopic ultrasonography and intraductal ultrasonography showed a hypoechoic mass limited to the ampulla of Vater. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a slightly dilated ventral pancreatic duct not connected to the dorsal duct. Endoscopic papillectomy was performed without pancreatic stent placement and his postprocedural course was uneventful. The specimen was histologically diagnosed as well-differentiated adenocarcinoma limited to the mucosa of the ampulla of Vater. Endoscopic papillectomy without pancreatic stent placement can be performed without a risk of post-ERCP pancreatitis for ampullary tumor limited to the mucosa of the ampulla of Vater associated with pancreas divisum.
一名60多岁的男性接受了体检，食管胃十二指肠镜检查显示在 Vater 壶腹处有一个隆起型肿瘤。内镜超声和导管内超声显示一个低回声肿块局限于 Vater 壶腹。内镜逆行胰胆管造影（ERCP）显示腹侧胰管轻度扩张，与背侧胰管不相连。在未放置胰管支架的情况下进行了内镜乳头切除术，术后过程顺利。标本经组织学诊断为局限于 Vater 壶腹黏膜的高分化腺癌。对于局限于与胰腺分裂相关的 Vater 壶腹黏膜的壶腹肿瘤，在不放置胰管支架的情况下进行内镜乳头切除术不会有 ERCP 后胰腺炎的风险。
