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随着内镜检查技术的发展,十二指肠乳头肿瘤早期的检出率有所提高。良性肿瘤密切随访监测不适合我国国情,外科手术又因严重并发症发生率和病死率较高而得不偿失。内镜十二指肠乳头肿瘤切除术因其微创、安全逐渐被接受,但治疗策略仍存在争议。术前评估时须对肿瘤进行精确活检,以获得初步病理学诊断;对于高度疑癌病灶,行超声内镜进行浸润深度评估,内镜逆行胰胆管造影(ERCP)进行胰胆管浸润程度的评估,指导治疗方案选择。内镜十二指肠乳头肿瘤切除术标准流程尚存争议,但推荐预防性放置胰管支架及吲哚美辛栓纳肛,以减少术后胰腺炎的发生风险。治疗后病人均需定期进行内镜随访,观察有无肿瘤残留及复发。建议结合临床资料、术者能力,平衡并发症和疾病风险,选择个体化治疗方式。
With the development of endoscopy, early detection rate of duodenal papillary tumors has increased. Close follow-up monitoring of benign tumors is not suitable for China’s national conditions, surgery and serious complications due to the high incidence and mortality not worth the candle. Endoscopic duodenal papilla resection due to its minimally invasive, safety gradually accepted, but the treatment strategy is still controversial. Tumor biopsy should be performed preoperatively to obtain preliminary pathological diagnosis. For highly suspected cancer lesions, endoscopic ultrasonography was performed to evaluate the infiltration depth and endoscopic retrograde cholangiopancreatography (ERCP) for pancreaticobiliary invasion. Guide treatment options. Endoscopic papillary tumor resection standard procedure is controversial, but the recommended placement of pancreatic duct stent and indometacin suppository to reduce the risk of postoperative pancreatitis. Patients after treatment are required to carry out regular endoscopic follow-up to observe whether the tumor residual and recurrence. Recommendations combined with clinical data, surgeon capacity, balance complications and disease risk, choose individualized treatment.