Benito Ruiz J, Del Pino Porres J, Herrero Bernabéu C
Rev Esp Enferm Apar Dig. 1989 Aug;76(2):144-50.
Cancer of ampulla of Vater is a infrequent tumor which was a much better prognosis after radical treatment than cancer of the pancreas. In this paper, 25 patients were studied, with a mean age of 59 years and a slight male predominance. The most frequent symptoms were related to jaundice and weight loss. The correct preoperative diagnosis was only reached in 54.16% of the patients, endoscopic retrograde cholangiopancreatography being the best diagnostic method, together with ?CTPH. We emphasize the difficulty of reaching a diagnosis and the variable results of both pre- and peroperative biopsy. The results of surgical treatment (9 Whipple operations, 7 ampullectomies and 7 bypass operations) are evaluated, showing that duodenopancreatectomy is the most effective therapy, although we had only one 5-year survival, 11.1% versus 0% for ampullectomy, which is an operation that carriers an elevated recurrence rate (greater than 50%). The mortality derived from Whipple's operation was 22.2%, and from local excision, 14.3%. The rate of complications was 55.5% after cephalic duodenopancreatectomy and null after ampullectomy. In view of these results, we think that the most appropriate therapeutic approach to ampulloma is the Whipple operation, and that ampullectomy should be reserved for those patients in poor general condition with small tumors, and that bypass operations should be used when the tumor is not resectable.
壶腹癌是一种罕见的肿瘤，根治性治疗后的预后比胰腺癌好得多。本文研究了25例患者，平均年龄59岁，男性略占优势。最常见的症状与黄疸和体重减轻有关。仅54.16%的患者术前得到了正确诊断，内镜逆行胰胆管造影术是最佳诊断方法，联合CTPH。我们强调了诊断的困难以及术前和术中活检的可变结果。对手术治疗结果（9例惠普尔手术、7例壶腹切除术和7例旁路手术）进行了评估，结果表明十二指肠胰腺切除术是最有效的治疗方法，尽管我们只有1例5年生存率，壶腹切除术的5年生存率为11.1%，而壶腹切除术的复发率较高（大于50%）。惠普尔手术的死亡率为22.2%，局部切除的死亡率为14.3%。胰头十二指肠切除术后的并发症发生率为55.5%，壶腹切除术后无并发症。鉴于这些结果，我们认为对壶腹瘤最合适的治疗方法是惠普尔手术，壶腹切除术应保留给那些一般状况较差且肿瘤较小的患者，当肿瘤无法切除时应采用旁路手术。
