Department of Gastroenterology and Hepatology, North Hospital, Marseille, France.
Surg Endosc. 2012 Apr;26(4):920-5. doi: 10.1007/s00464-011-1968-7. Epub 2011 Oct 20.
The utility of endoscopic ampullectomy versus surgical ampullectomy remains a topic of debate, particularly for the treatment of malignant tumors. The goal of this study was to prospectively establish the outcomes of endoscopic ampullectomy, with focus on carcinoma.
From February 2002 to December 2008, 61 patients underwent endoscopic ampullectomy. The ampulloma was discovered fortuitously in the majority of cases (43 patients, 70%). All patients had had an echoendoscopy revealing a T1N0 lesion without invasion of the orifice.
Forty-three patients (70%) underwent a monobloc resection. Histological analysis revealed a low-grade dysplastic adenoma in 21 patients (35%), a high-grade dysplastic adenoma in 11 patients (18%), no dysplasia in 16 patients (26%), an adenocarcinoma in 10 patients (16%), and a well-differentiated endocrine carcinoma in 3 patients (5%). Among the ten patients with adenocarcinoma, four with adenocarcinoma of poor prognosis were treated by pancreaticoduodenectomy (PD) with R0 resection, of whom one patient had no more lesion. Two intramucosal adenocarcinomas were cured by endoscopic ampullectomy without any recurrence. Four patients received palliative care after endoscopic ampullectomy due to cephalic pancreatico-duodenectomy contraindication. For the three patients with well-differentiated endocrine carcinomas, one was treated by PD with R0 resection and two were treated solely by endoscopic ampullectomy, without recurrence. Eleven patients (18%) presented with complications. The complication rate was 30.5% for carcinomas versus 14.5% for benign tumors (p < 0.05).
Endoscopic ampullectomy allows for the oncologic resection of well-differentiated intramucosal carcinomas with negative margins. The risk of complications is greater for papillary carcinomas.
内镜壶腹切除术与外科壶腹切除术的效用仍然存在争议，尤其是在恶性肿瘤的治疗方面。本研究的目的是前瞻性地建立内镜壶腹切除术的结果，重点是癌。
从 2002 年 2 月至 2008 年 12 月，61 例患者接受了内镜壶腹切除术。大多数情况下（43 例，70%）是偶然发现壶腹瘤的。所有患者均进行了回声内镜检查，结果显示 T1N0 病变且无开口处侵犯。
43 例（70%）患者行整块切除术。组织学分析显示，21 例（35%）为低级别异型增生腺瘤，11 例（18%）为高级别异型增生腺瘤，16 例（26%）无异型增生，10 例（16%）为腺癌，3 例（5%）为分化良好的内分泌癌。在 10 例腺癌患者中，4 例预后不良的腺癌患者行胰十二指肠切除术（PD）并获得 R0 切除，其中 1 例患者无病变残留。2 例黏膜内腺癌患者经内镜壶腹切除术治愈，无复发。由于头侧胰十二指肠切除术禁忌，4 例患者在接受内镜壶腹切除术治疗后接受姑息治疗。对于 3 例分化良好的内分泌癌患者，1 例患者行 PD 并获得 R0 切除，2 例患者仅行内镜壶腹切除术，无复发。11 例（18%）患者出现并发症。癌的并发症发生率为 30.5%，良性肿瘤为 14.5%（p<0.05）。
内镜壶腹切除术可对有阴性切缘的分化良好的黏膜内癌进行肿瘤性切除。乳头状癌的并发症风险更高。
