Beger H G, Staib L, Schoenberg M H
Department of General Surgery, University of Ulm, Germany.
Langenbecks Arch Surg. 1998 Apr;383(2):190-3. doi: 10.1007/s004230050117.
The frequency of malignant adenomas of the papilla figures between 15 and 30%. Villous adenoma is considered to be a premalignant lesion.
Resection of the papilla is indicated in large tubular and small tubulovillous adenoma. Ampullectomy, however, is mandatory in villous adenoma with severe dysplasia and large villous or tubulovillous adenoma. If villous adenoma with a low-risk pT1 N0 M0 G1/2-cancer is treated by ampullectomy, local lymph dissection should also be performed. Ampullectomy includes extirpation of the ampulla of Vater and reinsertion of the common bile duct and the pancreatic main duct into the duodenal wall.
Hospital mortality after ampullectomy is less than 0.4%, and surgical morbidity, e.g., cholangitis, below 10%.
乳头恶性腺瘤的发生率在15%至30%之间。绒毛状腺瘤被认为是一种癌前病变。
对于大的管状和小的管状绒毛状腺瘤，建议行乳头切除术。然而，对于有严重发育异常的绒毛状腺瘤以及大的绒毛状或管状绒毛状腺瘤，必须行壶腹切除术。如果低风险的pT1 N0 M0 G1/2期癌性绒毛状腺瘤通过壶腹切除术治疗，也应进行局部淋巴结清扫。壶腹切除术包括切除Vater壶腹并将胆总管和胰主胰管重新植入十二指肠壁。
壶腹切除术后的医院死亡率低于0.4%，手术并发症，如胆管炎，低于10%。
