Sivak M V
Cleveland Clinic, Ohio.
Endoscopy. 1988 Aug;20 Suppl 1:211-7. doi: 10.1055/s-2007-1018178.
Diverse tumors may arise at the ampulla of Vater, although the clinical manifestations for all types of lesions are similar. Carcinoma and benign adenomas are the most important ampullary tumors, and there is evidence that adenomas are premalignant. Endoscopy offers the best prospect of accurate diagnosis, but the sensitivity and specificity of this diagnostic modality is less than expected. In particular, endoscopic biopsies may be falsely negative for carcinoma in a significant percentage of cases. When successful, ERCP may demonstrate dilated pancreatic and bile ducts and in some cases the presence of a tumor mass. The preferred treatment for virtually all ampullary tumors is surgery, the general types of operation being local resection, pancreatoduodenectomy, and biliary decompression procedures. The choice of operation depends on whether the tumor is benign or malignant, its extent, especially if malignant, and an assessment of the patient's ability to withstand radical resection. Although the operative morbidity and mortality is lower for local excision in comparison to pancreatoduodenectomy, there is a greater chance for recurrence of malignant and premalignant neoplasms when the tumor is locally excised.
尽管所有类型病变的临床表现相似，但不同的肿瘤可能发生在 Vater 壶腹。癌和良性腺瘤是最重要的壶腹肿瘤，并且有证据表明腺瘤是癌前病变。内镜检查提供了准确诊断的最佳前景，但这种诊断方式的敏感性和特异性低于预期。特别是，在相当比例的病例中，内镜活检对癌可能出现假阴性结果。成功进行 ERCP 时，可显示胰管和胆管扩张，在某些情况下还可显示肿瘤块的存在。几乎所有壶腹肿瘤的首选治疗方法是手术，一般的手术类型包括局部切除、胰十二指肠切除术和胆道减压手术。手术方式的选择取决于肿瘤是良性还是恶性、其范围，尤其是恶性肿瘤时，以及对患者耐受根治性切除能力的评估。尽管与胰十二指肠切除术相比，局部切除的手术发病率和死亡率较低，但当肿瘤进行局部切除时，恶性和癌前肿瘤复发的可能性更大。
