Penna C, Bataille N, Balladur P, Tiret E, Parc R
Department of Digestive Surgery, Hôpital Saint-Antoine, Paris, France.
Br J Surg. 1998 May;85(5):665-8. doi: 10.1046/j.1365-2168.1998.00684.x.
Patients with familial adenomatous polyposis (FAP) are at risk for adenomas and cancers in the duodenum but the ideal management of duodenal polyposis remains uncertain.
The outcome of surgical resection was analysed in 18 patients with FAP who had severe duodenal polyposis.
Duodenotomy and clearance of duodenal adenomas was performed seven times in six patients. There were two duodenal leaks and, after a mean follow-up of 53 (range 36-72) months, duodenal adenomas recurred in all patients and five had severe polyposis. Pancreatoduodenectomy was performed in seven patients with severe duodenal polyposis. Histology of the specimens revealed two unsuspected duodenal carcinomas at an early stage. After a mean follow-up of 42 months all patients were alive and well, and there was no case of jejunal polyposis. Pancreatoduodenectomy was attempted in five patients with duodenal cancer and only one survived more than 4 years.
Surgical excision of duodenal adenomas should be discussed before carcinoma occurs. Surgical polypectomy fails to guarantee a polyp-free duodenum and carries a risk of postoperative complications whereas pancreatoduodenectomy eliminates the risk of duodenal cancer with an acceptable morbidity rate. Pancreatoduodenectomy could be offered to some patients with large or multiple villous duodenal adenomas repeatedly showing severe dysplasia.
家族性腺瘤性息肉病（FAP）患者存在十二指肠腺瘤和癌症风险，但十二指肠息肉病的理想治疗方法仍不确定。
分析了18例患有严重十二指肠息肉病的FAP患者手术切除的结果。
6例患者进行了7次十二指肠切开术及十二指肠腺瘤清除术。发生了2例十二指肠漏，平均随访53（范围36 - 72）个月后，所有患者十二指肠腺瘤均复发，5例出现严重息肉病。7例严重十二指肠息肉病患者接受了胰十二指肠切除术。标本组织学检查发现2例早期未被怀疑的十二指肠癌。平均随访42个月后，所有患者均存活且情况良好，无空肠息肉病病例。5例十二指肠癌患者尝试进行胰十二指肠切除术，仅1例存活超过4年。
应在癌变前讨论十二指肠腺瘤的手术切除。手术息肉切除术不能保证十二指肠无息肉，且有术后并发症风险，而胰十二指肠切除术可消除十二指肠癌风险，发病率可接受。对于一些有大的或多发性绒毛状十二指肠腺瘤且反复显示严重发育异常的患者，可考虑行胰十二指肠切除术。
