经十二指肠局部切除在水乳头瘤中的作用?

Daniel Paramythiotis, Jörg Kleeff, Martin Wirtz, Helmut Friess, Markus W Büchler
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引用次数: 39

摘要

乳头及壶腹的肿瘤是一种罕见的肿瘤,由于其症状,通常在早期被发现。准确的壶腹肿瘤术前组织学诊断和分期往往是困难和不确定的,导致对这些病变的适当治疗的争议。目前有三种方法用于治疗这种肿瘤。在经验丰富的中心,胰十二指肠切除术(PD)是一种低发病率和死亡率的手术,被认为是治疗浸润性癌和怀疑恶性肿瘤的大良性壶腹病变的首选。经十二指肠局部切除壶腹肿瘤(TDE)是一种相对简单的手术,手术发病率和死亡率与PD相当。内窥镜中心的TDE受到内窥镜圈套切除术(ESE)的挑战。近年来,由于技术的进步,ESE治疗壶腹肿瘤的安全性和效果都有所提高。ESE和TDE是治疗良性肿瘤的适当方法,如果术前准确确定诊断和分期,对于早期发现的小恶性肿瘤也是如此。由于PD的安全性和ESE的技术进步,TDE是为选定的患者保留的。需要随机对照研究来确定PD、TDE和ESE的正确适应症。
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Still any role for transduodenal local excision in tumors of the papilla of Vater?

Tumors of the papilla and ampulla of Vater are rare neoplasms which are usually detected at an early stage due to their symptoms. The accurate preoperative histological diagnosis and staging of ampullary tumors is often difficult and inconclusive, leading to controversy over the adequate treatment of these lesions. Three procedures are currently being used to treat such tumors. Pancreatoduodenectomy (PD) is a procedure with low morbidity and mortality at experienced centers, and is considered the treatment of choice for invasive carcinoma and large benign ampullary lesions with suspicion of malignancy. Transduodenal local excision (TDE) of ampullary tumors is a relatively simple procedure with operative morbidity and mortality rates comparable to PD. TDE is challenged at endoscopic centers by endoscopic snare excision (ESE). Due to technical advances, the safety and outcomes of ESE for ampullary tumors have improved in recent years. ESE and TDE represent adequate methods for treatment of benign tumors and also for small malignant tumors detected at an early stage if the diagnosis and stage have been accurately established preoperatively. Due to the safety of PD and the technical advances of ESE, TDE is reserved for selected patients. Randomized controlled studies are needed to establish the correct indications for PD, TDE, and ESE.

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