Yeh C C, Lee P H, Lin J T, Wang T H
Department of Surgery, National Taiwan University, Taipei, R.O.C.
J Formos Med Assoc. 1993 Oct;92(10):914-6.
Benign tumors of the ampulla of Vater are uncommon. We report on two patients with epigastralgia, jaundice and pancreatitis caused by villous adenoma of the ampulla of Vater, combined with biliary tract stones, who were treated at National Taiwan University Hospital. Definite diagnoses were made by endoscopic retrograde cholangiopancreatography and biopsy. Their medical unsuitability for radical pancreaticoduodenectomy led us to revive the procedure of wide local excision of these tumors with reimplantation of the pancreatic duct and double sphincteroplasty. Operative time and blood loss were substantially less, and postoperative recovery was relatively uncomplicated. Hepatic resection for intrahepatic stones was performed later in the first case. Postoperative follow-up at 2.5 years showed no tumor recurrence. We suggest that local resection of benign ampullary tumors with double sphincteroplasty is the procedure of choice in high-risk patients.
Vater壶腹良性肿瘤并不常见。我们报告了两名在台湾大学医院接受治疗的患者，他们因Vater壶腹绒毛状腺瘤合并胆道结石而出现上腹部疼痛、黄疸和胰腺炎。通过内镜逆行胰胆管造影术和活检做出了明确诊断。由于他们在医学上不适合进行根治性胰十二指肠切除术，我们采用了对这些肿瘤进行广泛局部切除并重新植入胰管和双重括约肌成形术的方法。手术时间和失血量显著减少，术后恢复相对简单。第一例患者后来进行了肝内结石肝切除术。术后2.5年的随访显示无肿瘤复发。我们建议，对于高危患者，采用双重括约肌成形术对良性壶腹肿瘤进行局部切除是首选的手术方法。
