Delcore R, Connor C S, Thomas J H, Friesen S R, Hermreck A S
Department of Surgery, University of Kansas School of Medicine, Kansas City.
Am J Surg. 1989 Dec;158(6):593-6; discussion 596-7. doi: 10.1016/0002-9610(89)90201-8.
Twenty-eight patients with ampullary carcinoma were treated between 1965 and 1988: 22 underwent pancreaticoduodenectomy with 1 operative death (5 percent), 1 had local excision, 3 had bypass, and 2 were not explored. Of the 21 patients who survived pancreaticoduodenectomy, 4 had tumor confined to the ampulla, 7 had tumor extending into the duodenum, and 10 had tumor invasion beyond the duodenum. Nine of these patients had positive lymph nodes and 12 had negative lymph nodes. The patient who had local excision was disease-free at last follow-up 104 months postoperatively. Each of the three bypassed patients died of tumor progression within 15 months. The estimated 5-year survival rate for resected patients was 60 percent and was independently related to lymph node metastases (p = 0.031) and to tumor size (p = 0.039). This experience suggests that long-term survival is possible in patients with lymph node metastases or invasive tumors extending beyond the duodenal wall and that curative pancreaticoduodenectomy can be performed with a low operative mortality; therefore, aggressive surgical resection is recommended for all patients with ampullary carcinoma.
1965年至1988年间，对28例壶腹癌患者进行了治疗：22例行胰十二指肠切除术，1例手术死亡（5%），1例行局部切除术，3例行旁路手术，2例未进行探查。在胰十二指肠切除术后存活的21例患者中，4例肿瘤局限于壶腹，7例肿瘤延伸至十二指肠，10例肿瘤侵犯超过十二指肠。其中9例患者淋巴结阳性，12例淋巴结阴性。接受局部切除术的患者在术后104个月的最后一次随访时无疾病复发。3例接受旁路手术的患者均在15个月内死于肿瘤进展。切除术后患者的估计5年生存率为60%，且与淋巴结转移（p = 0.031）和肿瘤大小（p = 0.039）独立相关。该经验表明，伴有淋巴结转移或侵犯超过十二指肠壁的浸润性肿瘤患者有可能获得长期生存，且根治性胰十二指肠切除术可在较低的手术死亡率下进行；因此，建议对所有壶腹癌患者进行积极的手术切除。
