Duodenal papilla

When it comes to the duodenal papilla, most people are not familiar with it. There are many reasons for this type of disease. The common treatment method is surgery. Surgical treatment of the duodenal papilla can quickly relieve the condition and prevent the disease from continuing to develop. However, before surgery on the duodenal papilla, the patient needs to undergo various physical examinations, and the level of the disease must also be divided. The following is a detailed introduction to the duodenal papilla.

Patients with duodenal papillary tumors are difficult to diagnose due to the lack of specific symptoms and signs in the early stages, especially before jaundice occurs. Using B-ultrasound to detect mild to moderate dilatation of the intrahepatic and extrahepatic bile ducts as a clue and further examination to make an early diagnosis is still a practical and effective method. In this group, all 16 cases were found to have dilatation of the intrahepatic and extrahepatic bile ducts through multiple B-ultrasound examinations. In 3 cases, the diameter of the common bile duct reached 10-13 mm before the onset of jaundice. B-ultrasound can also detect pancreatic duct dilatation at the same time, with a detection rate of 75% (12/16) in this group. If the bile and pancreatic ducts are dilated at the same time, a papillary space-occupying lesion should be highly suspected and further fiberoptic duodenoscopy should be performed. It is an important method for early diagnosis of duodenal papilla tumors and should be included in routine. In this group, 6 cases underwent this examination, 4 were diagnosed, and the compliance rate was 66%.

Duodenectomy. Local resection of the duodenal papilla can be used as a palliative surgical method for patients who cannot tolerate pancreaticoduodenectomy [1,2]. For early-stage duodenal papillary tumors, extensive resection of the intestinal wall around the papilla, the distal bile duct, and the pancreatic duct can also play a radical role to some extent. Literature reports that the mortality rate of this surgery is significantly lower than that of pancreaticoduodenectomy, while the 5-year survival rate is similar [2]. The indications for local resection are well-differentiated duodenal papillary carcinoma, tumor diameter <10 mm, and no lymph node metastasis.

We feel that careful intraoperative exploration is very important for the diagnosis and treatment of duodenal papillary carcinoma. We should explore the retroperitoneal part of the duodenum, palpate the papillary lesions, and understand the lymph node metastasis. When performing local resection, the cutting edge should be at least 10 mm away from the tumor. Attention should be paid to finding the dilated pancreatic duct to prevent damage and to ensure that the bile and pancreatic duct opens into the intestinal cavity to prevent complications of bile and pancreatic fistula. Routinely perform three biopsies at the intestinal margin and bile and pancreatic duct. If residual tumor is found, the resection range should be expanded or pancreaticoduodenectomy should be performed instead.

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