Laparoscopy transduodenal papillectomy of papillary tumor: a report of 6 cases

doi:10.3877/cma.j.issn.1674-6899.2022.04.011

Abstract

Abstract:

Objective

To investigate the safety and feasibility of laparoscopic transduodenal pullectomy (LTDP) of papillary tumor.

Methods

The clinicopathological data, surgical procedures, perioperative treatment measures and follow-up information of six LTDP patients from Mar. 2020 to Jan. 2021 in the Binzhou Medical University Hospital were retrospectively analyzed.

Results

The average operation time of six patients was 342.2 min, the average intraoperative bleeding volume was about 46.7 ml. The average time of trans-oral fluid diet was about 4.2 d, the average exhaust time was 49.3 h, and the average postoperative hospital stay was 12 d. Postoperative pathology: 1 case of duodenal papillary mucinous adenocarcinoma, 2 cases of duodenal papillary tubular-villous adenoma, and 3 cases of duodenal papillary adenocarcinoma, all with negative margins. There were no perioperative deaths in six patients, one patient had postoperative duodenal hemorrhage, and the rest had no complications.The average postoperative follow-up was 19.6 months (16-25 months), and one patient with duodenal papillary adenocarcinoma had local tumor recurrence at 20 months and underwent palliative surgical treatment; the remaining patients had no tumor recurrence.

Conclusions

LTDP is safe and feasible in patients with benign duodenal papillary tumors borderline tumors, duodenal papilladenoma, duodenal papillary carcinoma in situ, stage T1 tumors without lymph node metastasis, and duodenal papillary malignant tumors at advanced age and with underlying diseases.

Key words: Duodenal papillary tumor, Transduodenal pullectomy, Laparoscopic

Haibin Ji, Jian Shi, Wentao Zhu, Xiaotong Lyu, Baolei Zhao, Baofang Sun, Xingyuan Zhang, Qinghai Guan, Fan Zhang, Qiangpu Chen. Laparoscopy transduodenal papillectomy of papillary tumor: a report of 6 cases[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2022, 15(04): 240-244.

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URL: https://zhqjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6899.2022.04.011

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References 32

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病例	年龄(岁)	性别	CA199 (U/ml)	CEA (ng/ml)	γ-GT (U/L)	ALB (U/L)	合并症
1	77	男	72.52	4.80	1 323.6	384.5	肺纤维化、冠心病、营养风险
2	58	女	9.08	1.20	209.9	303.9	无
3	80	女	71.02	3.61	673.9	761.2	高血压3级很高危，冠心病，营养不良
4	70	女	4.70	1.31	19.8	162.5	脑梗死、营养风险
5	71	女	125.10	7.03	1 090.3	508.5	高血压3级很高危、营养风险
6	64	男	15.77	3.19	386.0	367.0	无
病例	ALT(U/L)	AST(U/L)	TBIL(μmol/L)	DBIL(μmol/L)	体质量指数(kg/m²)	营养风险评估(NRS2002)(分)	术前内镜病理检查结果
1	196.2	141.5	82.82	47.05	27.89	3	腺癌
2	983.7	878.3	17.68	4.36	21.48	0	低级别异型增生，局灶高级别
3	114.2	134.4	43.89	18.89	17.80	5	黏膜急(慢)性炎症
4	11.2	16.5	7.54	1.23	22.21	3	黏膜炎症，局部腺体不典型增生
5	134.1	160.6	177.96	108.81	22.25	3	黏膜炎症，局部腺体结构紊乱
6	51.2	19.8	20.70	7.30	23.59	0	管状-绒毛状腺瘤，低级别异型增生，局灶高级别

病例	年龄(岁)	性别	CA199 (U/ml)	CEA (ng/ml)	γ-GT (U/L)	ALB (U/L)	合并症
1	77	男	72.52	4.80	1 323.6	384.5	肺纤维化、冠心病、营养风险
2	58	女	9.08	1.20	209.9	303.9	无
3	80	女	71.02	3.61	673.9	761.2	高血压3级很高危，冠心病，营养不良
4	70	女	4.70	1.31	19.8	162.5	脑梗死、营养风险
5	71	女	125.10	7.03	1 090.3	508.5	高血压3级很高危、营养风险
6	64	男	15.77	3.19	386.0	367.0	无
病例	ALT(U/L)	AST(U/L)	TBIL(μmol/L)	DBIL(μmol/L)	体质量指数(kg/m²)	营养风险评估(NRS2002)(分)	术前内镜病理检查结果
1	196.2	141.5	82.82	47.05	27.89	3	腺癌
2	983.7	878.3	17.68	4.36	21.48	0	低级别异型增生，局灶高级别
3	114.2	134.4	43.89	18.89	17.80	5	黏膜急(慢)性炎症
4	11.2	16.5	7.54	1.23	22.21	3	黏膜炎症，局部腺体不典型增生
5	134.1	160.6	177.96	108.81	22.25	3	黏膜炎症，局部腺体结构紊乱
6	51.2	19.8	20.70	7.30	23.59	0	管状-绒毛状腺瘤，低级别异型增生，局灶高级别

病例	手术方式	手术时间(min)	术中出血量(ml)	术后病理检查结果	肿瘤大小(cm)	术后住院时间(d)
1	LTDP+胆总管T管引流术	445	50	中-高分化腺癌	2.5×1.5	8
2	LTDP	475	50	管状-绒毛状腺瘤	2.3×1.5	9
3	LTDP	330	30	中分化腺癌	2.0×1.5	24
4	LTDP	374	100	黏液腺癌	1.3×0.9	12
5	LTDP	247	20	高分化腺癌	1.2×1.0	11
6	LTDP	182	30	管状-绒毛状腺瘤	2.5×1.8	8
病例	术后经口进食时间(d)	术后并发症	加速康复外科措施^a	随访时间(月)	随访结果
1	4	无	①②③④⑤⑥⑦⑧⑩⑪	25	肿瘤复发
2	3	无	①②③④⑤⑥⑦⑧⑨⑩⑪	21	无复发
3	4	消化道出血	①②③④⑤⑥⑦⑧⑨⑩⑪	20	无复发
4	5	无	①②③④⑤⑥⑦⑧⑨⑩⑪	18	无复发
5	5	无	①②③④⑤⑥⑦⑧⑨⑩⑪	18	无复发
6	4	无	①②③④⑤⑥⑦⑧⑨⑩⑪	16	无复发

病例	手术方式	手术时间(min)	术中出血量(ml)	术后病理检查结果	肿瘤大小(cm)	术后住院时间(d)
1	LTDP+胆总管T管引流术	445	50	中-高分化腺癌	2.5×1.5	8
2	LTDP	475	50	管状-绒毛状腺瘤	2.3×1.5	9
3	LTDP	330	30	中分化腺癌	2.0×1.5	24
4	LTDP	374	100	黏液腺癌	1.3×0.9	12
5	LTDP	247	20	高分化腺癌	1.2×1.0	11
6	LTDP	182	30	管状-绒毛状腺瘤	2.5×1.8	8
病例	术后经口进食时间(d)	术后并发症	加速康复外科措施^a	随访时间(月)	随访结果
1	4	无	①②③④⑤⑥⑦⑧⑩⑪	25	肿瘤复发
2	3	无	①②③④⑤⑥⑦⑧⑨⑩⑪	21	无复发
3	4	消化道出血	①②③④⑤⑥⑦⑧⑨⑩⑪	20	无复发
4	5	无	①②③④⑤⑥⑦⑧⑨⑩⑪	18	无复发
5	5	无	①②③④⑤⑥⑦⑧⑨⑩⑪	18	无复发
6	4	无	①②③④⑤⑥⑦⑧⑨⑩⑪	16	无复发

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