Ismail Shamel, Marianne Udd, Heikki Järvinen, Jorma Halttunen, Leena Kylänpää
Department of Gastrointestinal and General Surgery, Helsinki University Central Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland.
Surg Endosc. 2014 Nov;28(11):3234-9. doi: 10.1007/s00464-014-3596-5. Epub 2014 Jun 14.
Endoscopic removal of benign tumours of papilla is increasing. Our aim was to evaluate the outcome of endoscopic resection of papillary tumours.
In the years 2000-2012, 61 papillectomies were performed in Helsinki University Central Hospital. The cases were analysed retrospectively.
There were 35 patients with benign tumour of papilla without familial adenomatous polyposis (FAP), 16 patients with FAP and 10 patients with ampullary cancer. Jaundice and bile duct dilation were risk factors for malignancy (p < 0.001). In benign tumours, the recurrence rate was 25.5 %. In 5/51 benign tumour cases (9.8 %), a pancreaticoduodenectomy was performed. The remaining cases were treated endoscopically. Neither tumour size, resection in one piece or piecemeal technique, nor coagulation of resection margins had an effect on the development of residual tumour. The total complication rate was 24.6 %. Pancreatitis developed in six patients (9.8 %, 3 mild and 3 moderate). In benign tumour cases, pancreatic stent decreased pancreatitis rate (p = 0.045). In cases where only a pancreatic sphincterotomy was performed, the risk of pancreatitis was high 4/7 (57 %). Bleeding was the most common complication (18 %). Only one patient was operated due to complication, a post-papillectomy bleeding. In six out of seven non-operated cancer patients, the disease progressed.
Endoscopic papillectomy is an effective procedure for treating benign papillary tumours. Jaundice and bile duct dilation are more common in malignant tumours. Pancreatic stent decreases the risk of post-papillectomy pancreatitis. Pancreatic sphincterotomy without stenting carries a high risk of pancreatitis. For papillary cancer, surgery is recommended.
内镜下切除乳头良性肿瘤的应用日益增多。我们的目的是评估内镜切除乳头肿瘤的效果。
2000年至2012年期间，赫尔辛基大学中心医院共进行了61例乳头切除术。对这些病例进行回顾性分析。
35例乳头良性肿瘤患者无家族性腺瘤性息肉病（FAP），16例FAP患者，10例壶腹癌患者。黄疸和胆管扩张是恶性肿瘤的危险因素（p<0.001）。良性肿瘤的复发率为25.5%。51例良性肿瘤病例中有5例（9.8%）接受了胰十二指肠切除术。其余病例采用内镜治疗。肿瘤大小、整块切除或分片切除技术以及切除边缘的凝固均对残留肿瘤的发生无影响。总并发症发生率为24.6%。6例患者发生胰腺炎（9.8%，3例轻度，3例中度）。在良性肿瘤病例中，放置胰管支架可降低胰腺炎发生率（p=0.045）。仅行胰括约肌切开术的病例中，胰腺炎风险较高，为4/7（57%）。出血是最常见的并发症（18%）。仅1例患者因并发症（乳头切除术后出血）接受手术。7例未手术的癌症患者中有6例病情进展。
内镜乳头切除术是治疗乳头良性肿瘤的有效方法。黄疸和胆管扩张在恶性肿瘤中更常见。胰管支架可降低乳头切除术后胰腺炎的风险。未放置支架的胰括约肌切开术胰腺炎风险较高。对于乳头癌，建议手术治疗。
