内镜下十二指肠乳头切除术在乳头部肿瘤诊断中的价值

目的:评价内镜下十二指肠乳头切除术(endos-copic papillectomy,EP)在乳头部肿瘤诊断中的临床价值.方法:分析2008-01/2012-03来我院的16例经病理检查确诊的十二指肠乳头部肿瘤患者的相关资料,评价EP在十二指肠乳头部肿瘤诊断中的临床价值.结果:16例患者中,内镜活检诊断为腺瘤者12例,慢性炎症改变者4例.EP将乳头部肿瘤组织切除后整体送检行病理学检查确诊为低分化腺癌者2例,高分化腺癌1例,腺瘤13例(其中1例腺瘤恶变,4例常规内镜活检诊断为慢性炎症改变者术后均确诊为腺瘤),EP术后准确率明显高于内镜活检法(P<0.05).超声内镜(endoscopic ultrasonography,EUS)检查提示病变均起源于黏膜层,胰胆管扩张者9例,未见黏膜下层连续性中断及胰胆管受累者,无腹膜后淋巴结肿大者;12例高回声病变者术后病理检查结果均为腺瘤,1例高回声病变局部见低回声区者术后病理检查结果为腺瘤恶变,3例低回声病变者术后病理检查结果均为腺癌.EP术后2例低分化腺癌者、1例腺瘤恶变者及1例腺瘤者胆管开口处见病变残留,提示胆管受累,但术前EUS检查均未提示胆管受累;1例高分化腺癌及11例腺瘤者病灶均完整切除,术后切缘阴性.EP术后除2例出现黑便外,无急性胰腺炎、穿孔及其他并发症发生,无患者死亡.结论:EP术将乳头部肿瘤组织切除后整体送检行病理学检查可提高诊断准确率,为治疗方法的抉择提供科学依据.

Clinical evaluation of endoscopic papillectomy for the diagnosis of tumors of the ampulla of Vater

AIM:To evaluate the value of endoscopic papil-lectomy (EP) for the diagnosis of tumors of the ampulla of Vater. METHODS:The clinical data for 16 patients with tumors of the ampulla of Vater were analyzed. The clinical efficacy,complications and safety of EP were evaluated.RESULTS:Before EP,12 patients were diag-nosed with adenoma and 4 with chronic in-flammation by endoscopic biopsy. After EP,2 cases were diagnosed with poorly differenti-ated adenocarcinoma,1 with well differentiated adenocarcinoma,and 13 with adenoma (including one case of adenoma with malignant transformation and all 4 cases diagnosed with "chronic inflammation" by endoscopic biopsy). The accuracy of EP was significantly higher than that of endoscopic biopsy (P < 0.05). In 9 cases,EUS showed that the lesions originated from the submucosal layer with dilated pan-creatic and biliary ducts. None of the cases had submucosal continuity interruption,invasion to pancreatic/biliary ducts or enlarged retroperitoneal lymph nodes on EUS. Twelve patients with high echoic lesions were confirmed to have adenoma,one patient with hyperechoic lesion with localized low echo area were confirmed to have adenoma with malignant transformation,and 3 patients with low echo lesions were confirmed to have adenocarcinoma. After EP,residual lesions were found in bile duct orifice in 2 cases of poorly differentiated adeno-carcinoma,1 case of adenoma with malignant transformation and 1 case of adenoma,indicat-ing invasion to the bile duct. All of them had a negative preoperative EUS. Lesions were com-pletely resected in 1 case of well differentiated adenocarcinoma and 11 cases of adenoma,and the resection stump was histologically negative for neoplasm. After EP,two patients developed transient melena,but no acute pancreatitis,per-foration or other complications occurred. There was no procedural-related death in this group of patients. CONCLUSION:EP is safe and has a higher accuracy in the diagnosis of tumors of the ampulla of Vater.