Bjork K J, Davis C J, Nagorney D M, Mucha P
Department of Surgery, Mayo Clinic, Rochester, Minn. 55905.
Arch Surg. 1990 Aug;125(8):961-5. doi: 10.1001/archsurg.1990.01410200019001.
The treatment of 36 patients with duodenal villous tumors was reviewed to determine the long-term outcome of various surgical treatment options for specific adenoma histopathology. Duodenal villous tumors were typically solitary and periampullary in location. Villous adenomas contained epithelial atypia in 30% of patients, in situ carcinoma in 14%, and invasive carcinoma in 33%. Treatment consisted of transduodenal submucosal excision in 19 patients and radical pancreaticoduodenectomy in 15. There was no perioperative mortality. Perioperative morbidity for transduodenal excision and pancreaticoduodenectomy was 16% and 47%, respectively. Benign adenomas recurred more than 5 years postoperatively in 17% of patients undergoing transduodenal excision. Five-year survival following radical resection for invasive cancers was 45%. Overall median follow-up was 5.8 years. We conclude that duodenal villous tumors without invasive cancer can be managed successfully by local submucosal excision, but invasive carcinoma requires radical resection.
回顾了36例十二指肠绒毛状肿瘤患者的治疗情况，以确定针对特定腺瘤组织病理学的各种手术治疗方案的长期结果。十二指肠绒毛状肿瘤通常为单发，位于壶腹周围。绒毛状腺瘤患者中，30%存在上皮异型增生，14%为原位癌，33%为浸润癌。19例患者接受了经十二指肠黏膜下切除术，15例接受了根治性胰十二指肠切除术。无围手术期死亡病例。经十二指肠切除术和胰十二指肠切除术的围手术期发病率分别为16%和47%。接受经十二指肠切除术的患者中，17%的良性腺瘤在术后5年以上复发。浸润性癌根治性切除术后的5年生存率为45%。总体中位随访时间为5.8年。我们得出结论，无浸润癌的十二指肠绒毛状肿瘤可通过局部黏膜下切除术成功治疗，但浸润性癌需要根治性切除。
