妊娠期壶腹腺癌管理中的挑战：一例病例报告及文献综述
Challenges in the management of adenocarcinoma of ampulla of Vater in pregnancy: A case report and review of literature.
作者信息
AlQattan Abdullah Saleh, Alkuwaiti Feras Ahmed, Alghusnah Elham Saleh, Bojal Shoukat Ahmad, Alqahtani Mohammed Saad
机构信息
Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
出版信息
Int J Surg Case Rep. 2019;61:38-43. doi: 10.1016/j.ijscr.2019.06.044. Epub 2019 Jun 26.
INTRODUCTION
Ampullary adenocarcinoma is a rare entity during pregnancy. It accounts for 0.5% of all gastrointestinal malignancies. The best treatment modality for resectable tumors with the best reported outcome is surgical resection in the form of pancreaticoduodenectomy (Whipple procedure). In this case report, we discuss the challenges in the management of ampullary adenocarcinoma in a pregnant patient.
CASE PRESENTATION
We report a case of 22 years old pregnant women who presented with vague abdominal pain and jaundice at the 28th week of gestation. Endoscopic retrograde cholangiopancreatography (ERCP) showed a stricture around the ampulla and distal common bile duct (CBD). The CBD was stented and a biopsy was taken. Histopathology revealed: an invasive adenocarcinoma. The patient was managed by elective pancreaticoduodenectomy after induction of vaginal delivery at the 34th week of gestation.
CONCLUSION
Diagnosing and managing ampullary adenocarcinoma in pregnant patients in their 3rd trimester is challenging. Yet, a delayed viable delivery followed by a definitive surgery in the form of pancreaticoduodenectomy offers the best outcomes for both the mother & fetus in case of early stage disease.
引言
壶腹腺癌在妊娠期较为罕见。它占所有胃肠道恶性肿瘤的0.5%。对于可切除肿瘤且报告结果最佳的最佳治疗方式是以胰十二指肠切除术（惠普尔手术）形式进行的手术切除。在本病例报告中，我们讨论了一名妊娠患者壶腹腺癌管理中的挑战。
病例介绍
我们报告一例22岁孕妇，在妊娠28周时出现模糊腹痛和黄疸。内镜逆行胰胆管造影（ERCP）显示壶腹周围及胆总管远端（CBD）狭窄。对CBD进行了支架置入并取了活检。组织病理学显示：浸润性腺癌。该患者在妊娠34周诱导阴道分娩后接受了择期胰十二指肠切除术。
结论
在妊娠晚期诊断和管理壶腹腺癌具有挑战性。然而，对于早期疾病，延迟进行可存活分娩，随后以胰十二指肠切除术形式进行确定性手术，对母亲和胎儿都能提供最佳结果。
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