Asbun H J, Rossi R L, Munson J L
Department of General Surgery, Lahey Clinic Medical Center, Burlington, MA 01805.
Arch Surg. 1993 May;128(5):515-20. doi: 10.1001/archsurg.1993.01420170045006.
Two of 14 patients with adenomas were without disease 25 and 43 months after ampullary resection. Two patients with an initial diagnosis of malignant neoplasm had no recurrence at 75 and 40 months; one underwent pancreatoduodenectomy at 8 months because of recurrence. Six of nine patients with initial diagnoses of villous adenoma were without disease at 1, 2, 16, 23, 46, and 51 months; three underwent conversion to pancreatoduodenectomy because of invasive carcinoma. Frozen-section studies revealed adenocarcinoma in two patients with villous adenoma but failed to show invasion in one patient. One patient with villous adenoma was mistakenly thought to have carcinoma based on results of frozen-section studies. Local ampullary resection is valuable in treating benign and selected premalignant and malignant ampullary lesions. The threshold for conversion to pancreatoduodenectomy should be low unless ampullectomy is performed with palliative intent.
14例腺瘤患者中有2例在壶腹切除术后25个月和43个月时无疾病。2例最初诊断为恶性肿瘤的患者在75个月和40个月时无复发；1例在8个月时因复发接受了胰十二指肠切除术。9例最初诊断为绒毛状腺瘤的患者中有6例在1、2、16、23、46和51个月时无疾病；3例因浸润性癌而改行胰十二指肠切除术。冰冻切片研究显示2例绒毛状腺瘤患者存在腺癌，但1例未显示有浸润。1例绒毛状腺瘤患者基于冰冻切片研究结果被误诊为癌。局部壶腹切除术对于治疗良性、部分癌前和恶性壶腹病变具有重要价值。除非壶腹切除术是出于姑息目的，否则改行胰十二指肠切除术的阈值应较低。
