经胆总管刮取组织法诊断壶腹癌(附13例报告)

DIAGNOSIS OF CARCINOMA OF AMPULLA VATER WITH SCRAPING PROCEDURE OF DISTAL COMMON BILE DUCT

经胆总管刮取组织法诊断壶腹癌13例,11例刮取组织中腺癌9例,腺瘤伴高度不典型增生、原位癌1例,绒毛乳头状瘤样增生1例。2例疑壶腹癌者刮取未得组织。常规胆总管探查术中适时应用此法有助于诊断未经注意的壶腹癌。在疑壶腹癌病例中采用本法诊断时多能得到阳性结果,但对刮取未得组织者应改用其它方法明确诊断。刮取组织病检诊为腺癌或绒毛肿瘤时有可能遗漏隐藏的恶性病变,故仍应将其完全切除病检。

The scraping procedure was adopted in 13 cases for diagnosis.of tumors of the ampulla vater. 11 of the 13 cases obtained tissue from distal common bile duct. Histological diagnoses included 9 adenocarcinoma, one adenoma with high atypical hyperplasia and carcinoma in situ,one villous papilomatous hyperplasia. No tissue obtained in two patients who were suspected to have ampullary carcinoma preoperatively. Adoptation of this method routinely during exploration of common bile duct would help diagnose the neglected carcinoma of ampulla vater. Most patients with malignancy of ampulla vater would obtain a positive result. However,a negative result could not rule out the diagnosis and other diagnostic tools should be used. If the tissues scraped were diagnosed as adenoma or villous tumor histologically, the malignant change might have been missed. Complete excision of the ampullary lesion is required to assess the presence or absence of malignancy accurately.