[Place of ampullectomy in the surgical treatment of tumors in Oddi's sphincter].
Ampoulectomy is rarely used for exeresis of tumours of the Oddi ampoula due to the risk of incomplete exeresis and postoperative complications. We performed 10 ampoulectomies between 1981 and 1990 (8 males, and 2 females: mean age 59 years). The operative procedure included wide resection followed by reimplantation of the biliary and pancreatic canals. The operative indications were based on converging evidence proficed by pathological examination of pre- and peroperative biopsies. There were 4 adenomas, 2 villous tumours, 2 ectopic pancreases, 1 somatostatinoma and 1 villous tumour with in situ carcinoma. Post-operative mortality was nil: the only post-operative complication was 1 stress ulcer. In one case, the benign nature of the tumour was infirmed by the pathological examination of the surgical specimen (invasive adenocarcinoma). This patient refused duodenopancreatectomy and died at recurrence 72 months later. For the other patients, mean post-operative follow-up was 60 months. Clinical, biological, endoscopic and pathological follow-up have not revealed relapse in any of the other patients. These results show that complete exeresis of benign Oddi tumors can be achieved by ampoulectomy without specific post-operative complications. Progress in echoendoscopy will probably lead to very precise evaluation of the local invasion of these tumours and thus to wider indications and better follow-up in operated patients.
Sielezneff
I
I
Service de Chirurgie Générale et Digestive, Hôpital Sainte-Marguerite, Marseille.
Belkhodjia
C
C
Sarles
J C
JC
Sastre
B
B
D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery*; D018253:Adenoma, Villous / Q000000981:diagnostic imaging / Q000601:surgery*; D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003138:Common Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010179:Pancreas / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging / Q000601:surgery
Place de l'ampullectomie dans le traitement chirurgical des tumeurs Oddiennes.