Büchler M, Rampf W, Baczako K, Lobeck H, Merkle P, Bittner R, Krautzberger W, Beger H G
Dtsch Med Wochenschr. 1984 Oct 26;109(43):1629-34. doi: 10.1055/s-2008-1069425.
Course of the disease and microscopic work-up of the operative specimens with special consideration of morphological carcinogenesis were analysed in 72 patients with tumour of the ampulla of Vater. Mean duration since onset of symptoms was 6.6 weeks. Cardinal symptoms were jaundice, loss of weight and abdominal pain. Endoscopic-retrograde cholangio-pancreatography, computed tomography and percutaneous transhepatic cholangiography had the highest diagnostic accuracy. Resection rate of the carcinoma was 55%, hospital mortality was 6.7% for partial duodenopancreatectomy and 15.4% for palliative surgery. The mean survival rate was 20 months after partial duodenopancreatectomy and 5 months after palliative surgery. The survival rate was significantly decreased if tumour size was above 2 cm and lymph nodes were positive for tumour. In 82.8% of the examined operative specimens moderate to high-grade epithelial dysplasias were found in carcinoma-free portions of the ampulla, and in 91.4% there were adenomatous structures. It is to be assumed that carcinoma of the ampulla develops via dysplastic epithelial changes or from adenoma of the ampulla.
对72例壶腹肿瘤患者的疾病进程及手术标本的显微镜检查进行了分析，特别考虑了形态学致癌作用。自症状出现以来的平均持续时间为6.6周。主要症状为黄疸、体重减轻和腹痛。内镜逆行胰胆管造影、计算机断层扫描和经皮肝穿刺胆管造影的诊断准确性最高。癌的切除率为55%，十二指肠胰头部分切除术的医院死亡率为6.7%，姑息性手术为15.4%。十二指肠胰头部分切除术后的平均生存率为20个月，姑息性手术后为5个月。如果肿瘤大小超过2 cm且淋巴结有肿瘤阳性，则生存率显著降低。在82.8%的检查手术标本中，在壶腹无癌部分发现中度至高度上皮发育异常，在91.4%中有腺瘤结构。可以推测，壶腹癌是通过发育异常的上皮变化或壶腹腺瘤发展而来的。
