Causeret S, François Y, Griot J B, Flourie B, Gilly F N, Vignal J
Department of Surgery, Hôpital Lyon Sud, Pierre Benite, France.
Int J Colorectal Dis. 1998;13(1):39-42. doi: 10.1007/s003840050129.
The frequency of duodenal adenomas in patients with, familial adenomatous polyposis is high. Duodenal adenoma has malignant potential, and duodenal adenocarcinoma is one of the main causes of death in patients who have had previous proctocolectomy. A conservative approach to the treatment of duodenal adenomas (nonsteroidal anti-inflammatory drugs, endoscopy, polypectomy through duodenotomy) is inefficient and unsafe. When invasive cancer occurs in duodenal adenomas, the result of surgery is poor. We have performed prophylactic pancreaticoduodenal resection (PDR) for nonmalignant severe duodenal polyposis in five patients since 1991. No operative mortality was observed. One patient developed a pancreatic fistula which was successfully managed by medical treatment. The mean follow-up was 35 months. All five patients are still alive and have a good functional outcome. Prophylactic PDR may be indicated in familial adenomatous polyposis when duodenal polyposis is severe. Stages III and IV of Spigelman's classification, periampullary adenoma, age above 40, and family history of duodenal cancer are factors that may lead to the decision to perform prophylactic PDR.
家族性腺瘤性息肉病患者十二指肠腺瘤的发生率很高。十二指肠腺瘤具有恶变潜能，十二指肠腺癌是既往接受过直肠结肠切除术患者的主要死亡原因之一。十二指肠腺瘤的保守治疗方法（非甾体类抗炎药、内镜检查、经十二指肠切开术切除息肉）效率低且不安全。当十二指肠腺瘤发生浸润性癌时，手术效果不佳。自1991年以来，我们对5例非恶性重度十二指肠息肉病患者进行了预防性胰十二指肠切除术（PDR）。未观察到手术死亡。1例患者发生胰瘘，经药物治疗成功处理。平均随访35个月。所有5例患者均存活，功能预后良好。当十二指肠息肉病严重时，家族性腺瘤性息肉病患者可能需要进行预防性PDR。Spigelman分类的III期和IV期、壶腹周围腺瘤、40岁以上以及十二指肠癌家族史是可能导致决定进行预防性PDR的因素。
