Hayes D H, Bolton J S, Willis G W, Bowen J C
Department of Surgery, Ochsner Clinic, New Orleans, LA 70121.
Ann Surg. 1987 Nov;206(5):572-7. doi: 10.1097/00000658-198711000-00003.
Thirty-five consecutive cases of adenocarcinoma of the ampulla of Vater seen over the past 36 years were reviewed. The introduction of new diagnostic techniques over the course of this study improved the accuracy of preoperative diagnosis but did not lead to earlier diagnosis. The surgical resectability rate was 88%, and 53% of postoperative survivors were free of disease at 5 years. Of the 14 patients with metastases to regional lymph nodes, 27% survived disease-free for 5 years. Surgical mortality was 25% for the entire series but has been reduced to 6.6% over the past decade. Surgical mortality was primarily due to leakage of the pancreaticojejunostomy; the risk of pancreaticojejunostomy leak correlated inversely with the degree of chronic pancreatitis in the pancreatic remnant. In 35% of resected cases, a benign adenomatous component was contained within the cancer of the ampulla of Vater. Cure rates are good for this lesion. The most important factor in maximizing cure rate is careful attention to the technical details of pancreaticojejunostomy in order to minimize surgical mortality. Benign adenomas appear to be a frequent precursor of carcinoma of the ampulla of Vater.
回顾了过去36年中连续收治的35例 Vater壶腹腺癌病例。在本研究过程中，新诊断技术的引入提高了术前诊断的准确性，但并未实现更早的诊断。手术切除率为88%，53%的术后存活者在5年后无疾病。在14例区域淋巴结转移患者中，27%存活且无疾病达5年。整个系列的手术死亡率为25%，但在过去十年中已降至6.6%。手术死亡主要归因于胰空肠吻合口漏；胰空肠吻合口漏的风险与胰腺残端慢性胰腺炎的程度呈负相关。在35%的切除病例中，Vater壶腹癌内含有良性腺瘤成分。该病变的治愈率良好。提高治愈率的最重要因素是仔细关注胰空肠吻合术的技术细节，以尽量降低手术死亡率。良性腺瘤似乎是Vater壶腹癌的常见前驱病变。
