Liu Feng, Cheng Jia-Lin, Cui Jing, Xu Zong-Zhen, Fu Zhen, Liu Ju, Tian Hu
Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, Shandong Province, China.
Department of Pathology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, Shandong Province, China.
World J Clin Cases. 2019 Mar 26;7(6):717-726. doi: 10.12998/wjcc.v7.i6.717.
Transduodenal ampullectomy (TDA) is not in wide clinical use due to its low radical effect and a high recurrence rate of tumors. However, TDA is still an effective treatment method; it has great clinical value in cases of duodenal benign tumors, precancerous lesions, and benign and malignant borderline tumors, and can avoid the risks associated with pancreaticoduodenectomy with larger resection range and greater thoroughness than endoscopic papillectomy.
To investigate the surgical method choice and the coincidence rate of pathological diagnoses in TDA for ampullary neoplasms.
Ten patients with ampullary neoplasms underwent TDA based on the fact that their endoscopic biopsy results suggested benign lesions, and the endoscopic ultrasound (EUS)-assessed tumors were resectable. All cases underwent duodenal ampullary lesion endoscopic biopsy, intraoperative frozen-section pathological examination, and postoperative pathological examination.
This study included seven patients with benign tumors and three with malignant tumors (1 pTis, 2 pT1), according to the postoperative pathology results. The coincidence rate of the postoperative pathology results with the intraoperative frozen-section biopsy results was 100% (10/10), and the coincidence rate with the endoscopic biopsy results was 70% (7/10) based on pathological characteristics. The endoscopic biopsy false-negative rate was 30% (3/10). All patients were followed for 6 to 70 mo without tumor recurrence or metastasis.
The coincidence rate of postoperative pathology results, intraoperative frozen-section pathology results, and endoscopic biopsy results is the restraining factor of TDA clinical application. Endoscopic biopsy results and EUS have importance relevance to surgical planning. Intraoperative frozen-section pathology results have a significant influence on the choice of surgical procedure.
十二指肠壶腹切除术（TDA）因其根治效果低、肿瘤复发率高，目前在临床中应用并不广泛。然而，TDA仍是一种有效的治疗方法；在十二指肠良性肿瘤、癌前病变以及良性与恶性交界性肿瘤的治疗中具有重要临床价值，且与胰十二指肠切除术相比，能避免更大范围切除带来的风险，同时比内镜乳头切除术更彻底。
探讨TDA治疗壶腹肿瘤的手术方法选择及病理诊断符合率。
10例壶腹肿瘤患者，基于内镜活检结果提示为良性病变且内镜超声（EUS）评估肿瘤可切除，接受了TDA治疗。所有病例均进行了十二指肠壶腹病变内镜活检、术中冰冻切片病理检查及术后病理检查。
根据术后病理结果，本研究包括7例良性肿瘤患者和3例恶性肿瘤患者（1例pTis，2例pT1）。术后病理结果与术中冰冻切片活检结果的符合率为100%（10/10），基于病理特征与内镜活检结果的符合率为70%（7/10）。内镜活检假阴性率为30%（3/10）。所有患者随访6至70个月，无肿瘤复发或转移。
术后病理结果、术中冰冻切片病理结果及内镜活检结果的符合率是TDA临床应用的制约因素。内镜活检结果和EUS与手术规划密切相关。术中冰冻切片病理结果对手术方式的选择有重大影响。
