Ghidirim G, Mişin I, Istrate V, Cazacu S
Department of Surgery "N. Anestiadi", Hepato- Bilio-Pancreatic Surgery Laboratory, University of Medicine and Pharmacy "N. Testemitsanu", Chişinău, Moldova.
Internal Medicine. Gastroenterology. Hepatology Department, University of Medicine and Pharmacy of Craiova, Gastroenterology Department - Emergency Hospital Craiova.
Curr Health Sci J. 2009 Apr;35(2):92-7. Epub 2009 Jun 16.
Adenomas of the duodenal papilla are rare. The frequency of malignant adenomas is 15-30%. Villous adenoma is a premalignant lesion with the highest rate of transformation. Options for surgical treatment include endoscopic and ablation resection, transduodenal ampullectomy, duodeno-pancreatectomy.
Evaluation of the efficacy and safety of endoscopic papillectomy for ampullary adenomas.
12 patients were selected (F:M, 5:7, age range 37 - 68 years) with ampullary adenoma, treated by endoscopic papillectomy. Biliary sphincterotomy was performed in 6 cases; and pancreatic sphincterotomy was performed in 3 cases. Biliary stenting was performed in 2 cases; pancreatic stent was placed in 11 cases.
En bloc resection was performed in 8 cases, and piecemeal resection in 4 cases. Complete resection R0 was noted in 10 cases. Pathology examination has show: tubulo-villous adenoma (5 patients); villous adenoma (4 patients), tubular adenoma (2 cases), adenocarcinoma (one case). Complications were immediate: bleeding (2 cases) and pancreatitis (1 case). Follow-up endoscopy reveals no ductal stenosis or recurrence.
Endoscopic papillectomy is a safe and well-tolerated alternative to surgical treatment of ampullary adenoma.
十二指肠乳头腺瘤罕见。恶性腺瘤的发生率为15% - 30%。绒毛状腺瘤是恶变率最高的癌前病变。手术治疗选择包括内镜下切除及消融、经十二指肠壶腹切除术、十二指肠 - 胰头切除术。
评估内镜下乳头切除术治疗壶腹腺瘤的疗效及安全性。
选取12例壶腹腺瘤患者（女:男，5:7，年龄范围37 - 68岁），采用内镜下乳头切除术治疗。6例行胆管括约肌切开术；3例行胰管括约肌切开术。2例行胆管支架置入；11例行胰管支架置入。
8例完整切除，4例分块切除。10例实现R0完整切除。病理检查显示：管状绒毛状腺瘤（5例）；绒毛状腺瘤（4例），管状腺瘤（2例），腺癌（1例）。即刻并发症有：出血（2例）和胰腺炎（1例）。随访内镜检查未发现导管狭窄或复发。
内镜下乳头切除术是治疗壶腹腺瘤的一种安全且耐受性良好的手术治疗替代方法。
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