Monson J R, Donohue J H, McEntee G P, McIlrath D C, van Heerden J A, Shorter R G, Nagorney D M, Ilstrup D M
Department of Surgery, Mayo Clinic, Rochester, MN 55905.
Arch Surg. 1991 Mar;126(3):353-7. doi: 10.1001/archsurg.1991.01410270099016.
One hundred four consecutive patients who underwent radical resection for ampullary cancer between 1965 and 1989 were retrospectively reviewed. Frequent clinical findings included jaundice (67%), significant (greater than 10%) weight loss (42%), and anemia (27%). Eighty-seven patients (84%) underwent a subtotal pancreatectomy, and 17 patients (16%) underwent a total pancreatectomy. The postoperative mortality was 5.7% (six patients), and reoperation for postoperative complications was required in six patients. The 5- and 10-year survival rates were 34% and 25%, respectively. Eight patients died of tumor recurrence more than 5 years after resection. Patient survival was significantly impaired by microscopic lymphatic invasion, regional nodal metastasis, tumor grade, and the epithelium of origin. In a multivariate analysis, only microscopic lymphatic invasion significantly reduced patient survival. Radical resection for ampullary cancer can be performed with a low morbidity and mortality and should remain the procedure of choice for ampullary carcinoma.
对1965年至1989年间连续104例行壶腹癌根治性切除术的患者进行回顾性研究。常见临床表现包括黄疸（67%）、显著（大于10%）体重减轻（42%）和贫血（27%）。87例患者（84%）接受了胰头十二指肠切除术，17例患者（16%）接受了全胰切除术。术后死亡率为5.7%（6例患者），6例患者因术后并发症需要再次手术。5年和10年生存率分别为34%和25%。8例患者在切除术后5年以上死于肿瘤复发。显微镜下淋巴侵犯、区域淋巴结转移、肿瘤分级和肿瘤起源上皮显著影响患者生存。多因素分析显示，仅显微镜下淋巴侵犯显著降低患者生存率。壶腹癌根治性切除术可在较低的发病率和死亡率下进行，应仍是壶腹癌的首选术式。
