家族性腺瘤性息肉病合并胆总管腺瘤的诊断与治疗
Diagnosis and treatment of familial adenomatous polyposis combined with adenomas in the common bile duct
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摘要:
家族性腺瘤性息肉病主要表现为结直肠布满腺瘤性息肉，常伴有胃或十二指肠息肉，但伴发胆总管息肉者极其罕见。2013年7月福建省立医院收治1例家族性腺瘤性息肉病并胆总管腺瘤的患者。患者于11个月前因急性胆管炎于外院行腹腔镜下胆总管切开探查和包块切除术，术后病理学检查结果为胆总管下段腺瘤。入院后检查发现胃、十二指肠、胆总管及结直肠多发息肉，活组织病理学检查结果提示为管状腺瘤，予行胰十二指肠切除术。术后病理学检查结果为十二指肠、胆总管管状腺瘤。患者术后恢复较好，经电话和门诊方式随访，患者除排便次数增多及偶有血便之外无特殊不适，术后7个月返院行全结肠切除术，术后病理学检查结果为管状腺瘤。
Abstract:Familial adenomatous polyposis is characte rized by the multiple and adenomatous polyps in the colorectum combined with polyps in the stomach and duodenum, while it is rarely seen in the common bile duct (CBD). In July 2013, 1 patient with FAP combined with adenomas in the CBD was admitted to the Fujian Provincial Hospital. The patient underwent laparoscopic CBD exploration and resection of masses due to acute pancreatitis 11 months ago, and was confirmed as with adenoma in the distal CBD by postoperative pathological examination. Multiple polyps were found in the stomach, duodenum, CBD, colorectum after admission to hospital, biopsy confirmed that polyps were tubular adenoma. The patient received pancreaticduodenectomy and was diagnosed as with duodenumCBD tubular adenoma in postoperative pathological examination. The patient was followed up by telephone interview and outpatient examination and had a full recovery, in addition to the increasing of stools frequency and occasioned hematochezia, and then was treated by total colectomy at postoperative month 7. The tubular adenoma was confirmed by postoperative pathological examination.
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