Gold M S, Bordley J
Department of Surgery, Mary Imogene Bassett Hospital, Cooperstown, NY 13326-1394.
Arch Surg. 1990 May;125(5):675-7. doi: 10.1001/archsurg.1990.01410170123026.
Periampullary neoplasms with necrosis or ulceration may have potentially troublesome and occasionally life-threatening bleeding. Four patients required pancreaticoduodenectomy for control of bleeding; three had adenocarcinoma of the duodenum and head of the pancreas, and one had an ulcerated carcinoid tumor of the duodenum. In two of these patients, incomplete resection was performed, and in one there was evidence of metastatic disease to the liver. Surgical results were excellent, postoperative courses were benign, and satisfactory palliation was provided. Improving morbidity and mortality with radical resection and aggressive radiotherapy and chemotherapy after surgery with the potential for bleeding from tumor necrosis make resection a reasonable alternative for palliation when localized but advanced disease exists.
伴有坏死或溃疡的壶腹周围肿瘤可能会出现潜在的棘手出血情况，偶尔甚至会危及生命。4例患者因控制出血而行胰十二指肠切除术；其中3例患有十二指肠和胰头腺癌，1例患有十二指肠溃疡型类癌肿瘤。在这2例患者中，手术切除不完全，1例有肝转移证据。手术效果良好，术后病程平稳，提供了满意的姑息治疗。对于存在肿瘤坏死出血风险的患者，通过根治性切除以及术后积极的放疗和化疗来改善发病率和死亡率，使得在局部但病情进展的情况下，切除成为一种合理的姑息治疗选择。
