Chijiiwa K, Yamashita H, Kuroki S
Department of Surgery, Kyushu University Faculty of Medicine, Fukuoka, Japan.
Int Surg. 1994 Apr-Jun;79(2):178-82.
Of 14 patients with ampullary tumor (11: carcinoma, 3: adenoma) treated during the last 8 years, two of 3 patients with adenoma underwent wide ampullectomy. We report herein the surgical procedure and its outcome with a special reference to the pancreaticobiliary ductal system with a mean follow-up period of 3.8 years. The procedure consisted of wide excision of the papilla encompassing the duodenal wall, the distal segments of pancreatic and common bile ducts, and a part of the pancreatic tissue adjacent to the duodenum. The distal ends of pancreatic and common bile ducts were sutured in a common duct manner and the openings were approximated to the excised duodenal wall. The pathological diagnosis was tubulo-villous adenoma with moderate atypia in both cases. The postoperative complications were absent except for a transient duodenal stenosis in one case. They have been free of recurrence and none developed pancreatobiliary diseases at the time of writing 49 and 44 months after ampullectomy. The duodenoscope clearly demonstrated the openings of the pancreatic and bile ducts and both ducts were not dilated on the endoscopic retrograde cholangiopancreaticogram. Wide ampullectomy is a choice of treatment for adenoma of papilla of Vater because of its non invasiveness and uneventful postoperative course.
在过去8年中治疗的14例壶腹肿瘤患者（11例为癌，3例为腺瘤）中，3例腺瘤患者中有2例行广泛壶腹切除术。我们在此报告手术过程及其结果，特别提及胰胆管系统，平均随访期为3.8年。手术包括广泛切除乳头，包括十二指肠壁、胰管和胆总管的远端以及十二指肠附近的部分胰腺组织。胰管和胆总管的远端以共同管道的方式缝合，开口靠近切除的十二指肠壁。两例病例的病理诊断均为中度异型性的管状绒毛状腺瘤。除1例出现短暂十二指肠狭窄外，无术后并发症。在壶腹切除术后49个月和44个月撰写本文时，他们无复发，也未发生胰胆管疾病。十二指肠镜清楚地显示了胰管和胆管的开口，在内镜逆行胰胆管造影中，两个管道均未扩张。由于广泛壶腹切除术具有非侵入性且术后过程平稳，因此是治疗 Vater 乳头腺瘤的一种选择。
