壶腹部肿瘤术前活检的诊断价值

Diagnostic value of preoperative biopsy in ampullary neoplasms

目的探讨壶腹部肿瘤术前活检的诊断价值。方法回顾性分析2000年1月至2009年11月本院收治的53例壶腹部肿瘤患者的十二指肠镜检及活检资料。结果所有患者术前均行十二指肠镜检查并活检。术前活检病理结果 :腺癌20例(37.7%),高级别上皮内瘤变19例(35.8%),低级别上皮内瘤变13例(24.5%),炎性息肉1例(1.9%)。53例患者中47例(88.7%)行胰十二指肠切除术,6例(11.3%)行肿瘤局部切除术。术后病理结果为:腺癌46例(86.8%),类癌1例(1.9%),腺瘤恶变3例(5.7%),腺瘤伴上皮内瘤变3例(5.7%)。结论多数壶腹部癌分化程度高,肿瘤表层活检难以做出正确诊断,肿瘤定性需结合病变形态、大小,必要时行切除活检。

Objective To investigate the diagnostic value of preoperative biopsy in ampullary tumor.Methods Clinical data of 53 patients with ampullary tumors who were treated in the First Affiliated Hospital of China Medical University from January 2000 to November 2009 were analyzed retrospectively.Results All of the patients were diagnosed preoperatively by duodenal endoscopy and biopsy.Among these cases,20 cases（37.7%） were diagnosed as adenocarcinoma,19 cases（35.8%）were diagnosed ashigh grade intraepithelial neoplasia,13 cases（24.5%）were diagnosed as low grade intraepithelial neoplasia and 1 cases（1.9%）were diagnosed as inflammatory polyp.In 53 cases of patients,47 cases（88.9%）underwent pancreaticoduodenectomy,6 cases（11.3%）underwent local tumor resection.Pathological results were as follows：adenocarcinoma in 46 cases（86.8%）,carcinoid in 1 case（1.9%）,adenoma with canceration in 3 cases（5.7%）,adenoma with intraepithelial neoplasia in 3 cases（5.7%）.Conclusions Most of the ampullary cancers have a high degree of differentiation,so biopsy in the surface of tumor is difficult to make a correct diagnosis.Qualitative diagnosis of ampullary tumor requires not only the biopsy,but also the shape and size ofthe tumor.Excision biopsyshould be made ifnecessary.