Güitrón A, Macías M, Abalid R, Gómez-Mejía A, Torres F
Departamento de Endoscopía Digestiva, Hospital de Especialidades Núm 71, Torreón, Coahuila.
Rev Gastroenterol Mex. 1995 Apr-Jun;60(2):78-83.
The ampullary carcinoma is a rare tumor. Its early and accurate diagnosis will lead to early treatment and subsequent better prognosis. Endoscopic retrograde cholangiopancreatography (ERCP) has been shown to be one of the best diagnostic tools. Furthermore an endoscopic biliary drainage procedure: endoscopic sphincterotomy or endoprosthesis placement, can be performed immediately following the diagnostic procedure.
Endoscopic drainage was attempted in 20 patients with a success rate of 90 percent. There were 8 females and 12 males, with a mean age of 71 years (range 43-92), and were admitted to the hospital with obstructive jaundice. Endoscopic insertion of a biliary endoprosthesis (9 cms long 3.2 mm [10 Fr] diameter), was successful in 18 patients whom made uneventful recovery and their jaundice resolved completely.
In 18 of them an endoscopic sphincterotomy was carried out. Two patients developed cholangitis, the endoprosthesis were removed and a new one inserted. The survival rate of these patients was 3 and 18 months respectively. Failure of endoscopic sphincterotomy or endoprosthesis insertion in 2 remaining patients, was ascribed to an inability to cannulate the papilla due to infiltrating tumor. The median survival time in 15 remaining patients was 4 months (1-18 months) and died by metastatic disease. Five patients underwent Whipple's procedure, and all survived the operation. Two died, by metastatic disease, with a median survival time of 16 months and 3 still alive at 46, 25 and 18 months post-operatively. Carcinoma of the ampulla of Vater is not resectable in 25-50% of the patients because of metastatic disease, deep extension of the tumor or general contraindications for major surgery.
Endoscopic sphincterotomy or endoprosthesis insertion as a definitive treatment modality should be reserved for poor surgical candidates and those patients with limited life expectancy due to metastatic disease.
壶腹癌是一种罕见肿瘤。其早期准确诊断将带来早期治疗及随后更好的预后。内镜逆行胰胆管造影术（ERCP）已被证明是最佳诊断工具之一。此外，一种内镜下胆道引流手术：内镜括约肌切开术或内置假体置入术，可在诊断性操作后立即进行。
对20例患者尝试进行内镜引流，成功率为90%。其中有8名女性和12名男性，平均年龄71岁（范围43 - 92岁），因梗阻性黄疸入院。18例患者成功进行了内镜下胆道内置假体置入（长9厘米，直径3.2毫米[10F]），这些患者恢复顺利，黄疸完全消退。
其中18例患者进行了内镜括约肌切开术。2例患者发生胆管炎，取出内置假体并插入新的。这2例患者的生存率分别为3个月和18个月。其余2例患者内镜括约肌切开术或内置假体置入失败，原因是肿瘤浸润导致无法插管至乳头。其余15例患者的中位生存时间为4个月（1 - 18个月），死于转移性疾病。5例患者接受了惠普尔手术，均存活下来。2例死于转移性疾病，中位生存时间为16个月，3例术后46、25和18个月仍存活。由于转移性疾病、肿瘤深度浸润或重大手术的一般禁忌证，25% - 50%的 Vater 壶腹癌患者无法切除。
内镜括约肌切开术或内置假体置入作为一种确定性治疗方式，应保留给手术条件差的患者以及因转移性疾病预期寿命有限的患者。
