Surgical ampullectomy: an underestimated operation in the era of endoscopy
Surgical ampullectomy: an underestimated operation in the era of endoscopy
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DOI：
10.1016/j.hpb.2015.07.004
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发表时间：
2016-01-01
期刊：
影响因子：
2.9
通讯作者：
Hackert, Thilo
中科院分区：
文献类型：
--
作者：
Schneider, Lutz;Contin, Pietro;Hackert, Thilo
简介：Vater壶腹的良性肿瘤、炎症或功能性病变主要通过初级内镜干预治疗。因此，经十二指肠壶腹切除术 (TSA) 已在许多中心被放弃，尽管它不仅是在内镜治疗失败后的一种重要工具。本研究的目的是分析 Vater 壶腹部良性病变的 TSA。 患者和方法：纳入 2001 年至 2014 年间接受 TSA 的所有患者。对患者的适应症、术后发病率和死亡率以及长期成功进行分析。结果：83 名患者接受了 TSA。适应症包括 44 名患者的腺瘤和 39 名患者的炎性狭窄。 96% 的患者在 TSA 之前接受过内窥镜治疗方法（干预次数中位数 n = 3）。 20 名患者 (24%) 发生术后并发症。发生 1 例手术相关死亡（死亡率 1.2%）。平均随访时间为 54 个月。 TSA 的长期总体成功率为 83.6%。壶腹腺瘤TSA术后复发率为4.5%。结论：TSA是一项被低估的外科手术，安全性高，远期疗效高。它可以应用于患有 Vater 壶腹部良性病变的患者的临床流程中，特别是在内镜治疗失败后。
Introduction: Benign neoplastic, inflammatory or functional pathologies of the ampulla of Vater are mainly treated by primary endoscopic interventions. Consequently, transduodenal surgical ampullectomy (TSA) has been abandoned in many centres, although it represents an important tool not only after unsuccessful endoscopic treatment. The aim of the study was to analyse TSA for benign lesions of the ampulla of Vater.Patients and methods: All patients who underwent TSA between 2001 and 2014 were included. Patients were analysed in terms of indications, postoperative morbidity and mortality as well as long-term success.Results: Eighty-three patients underwent TSA. Indications included adenomas in 44 and inflammatory stenosis in 39 patients. 96% of the patients had undergone endoscopic therapeutic approaches prior to TSA (median no. of interventions n = 3). Postoperative morbidity occurred in 20 patients (24%). There was one procedure-associated death (mortality 1.2%). The mean follow-up was 54 months. Long-term overall success rate for TSA was 83.6%. After TSA for ampullary adenoma, the recurrence rate was 4.5%.Conclusion: TSA is an underestimated surgical procedure, which can be performed safely with high long-term efficacy. It can be implemented in clinical algorithms for patients with benign pathologies of the ampulla of Vater, particularly after unsuccessful endoscopic treatment.