Barton R M, Copeland E M
Surg Gynecol Obstet. 1983 Mar;156(3):297-301.
A retrospective study of 56 patients with carcinoma of the ampulla of Vater revealed a resectability rate of 79.0 per cent and an operative mortality of 2.3 per cent. Although 55 per cent of those undergoing pancreaticoduodenectomy had complications postoperatively, these were usually self-limiting and did not require operative intervention. The five year survival rate was 23 per cent. The most significant pathologic determinant of long term survival was the nodal status at the time of exploration. Local recurrence after resection for cure was common as the first site of treatment failure and raises the question of the value of a more aggressive surgical approach or adjuvant radiation therapy to the surgical fields. The reason for a local recurrence appeared to be failure to remove all microscopic disease at the initial operation. Multifocal origin within the biliary tract could have contributed to the local recurrence. However, residual disease within the remaining pancreas after pancreaticoduodenectomy was a problem in only one patient. When disease was locally advanced, short term palliation was best accomplished by pancreaticoduodenectomy. However, survival beyond two years was no different from that of those treated by simple biliary bypass.
对56例 Vater壶腹癌患者进行的回顾性研究显示，可切除率为79.0%，手术死亡率为2.3%。尽管接受胰十二指肠切除术的患者中有55%术后出现并发症，但这些并发症通常为自限性，无需手术干预。五年生存率为23%。长期生存的最重要病理决定因素是探查时的淋巴结状态。根治性切除术后局部复发是常见的首次治疗失败部位，这引发了关于更积极的手术方法或手术野辅助放疗价值的问题。局部复发的原因似乎是初次手术时未能清除所有微小病灶。胆道内的多灶起源可能导致了局部复发。然而，胰十二指肠切除术后剩余胰腺内的残留病灶仅在1例患者中成为问题。当疾病局部进展时，胰十二指肠切除术最能实现短期姑息治疗。然而，两年以上的生存率与单纯胆肠吻合术治疗的患者并无差异。
