Shyr Y M, Su C H, Wang H C, Lo S S, Lui W Y
Department of Surgery, Veterans General Hospital-Taipei, Yang Ming Medical College, Taiwan, Republic of China.
J Am Coll Surg. 1994 Apr;178(4):369-78.
Two hundred and fifty-eight patients with pathologically proved periampullary carcinomas who underwent surgical treatment between the years 1965 and 1992 were evaluated. Comparison was carried out between the resectable and unresectable groups. Carcinoma of the pancreatic head occurred in less than one-half (47 percent) of the patients, and only 23 percent were resectable. In contrast, carcinoma of the ampulla of Vater had a similar rate of occurrence, but a much higher resectable rate (86 percent). Thus, carcinoma of the pancreatic head was the minor group (19 percent) in the resectable patients we studied. The main clinical presentations and durations of symptoms before diagnosis did not differ in the resectable and unresectable groups, so it was impossible to predict the resectability by symptoms. Incidences of diabetes mellitus and diarrhea increased twofold in the unresectable group. Preoperative biopsy was difficult to perform for those with carcinoma of the pancreatic head. Comparing pancreatoduodenectomy and palliative operation, pancreatoduodenectomy resulted in a higher complication rate (43 versus 13 percent), a higher surgical mortality rate (17 versus 9 percent) and a longer hospitalization period (31 versus 20 days), but there was no statistical difference in the median survival time between the resectable and unresectable carcinomas of the pancreatic head (seven and one-half versus five months). Most of the patients (81 percent in the resectable group and 70 percent in the unresectable group) we studied died of cachexia with tumor recurrence. Although the advantage of pancreatoduodenectomy for resectable carcinoma of the pancreatic head was questioned, we still recommend this procedure for all periampullary carcinomas to avoid depriving the occasional patients with pancreatic carcinomas of long term survival and forfeiting the chance of cure for some misdiagnosed patients with other more favorable periampullary carcinomas.
对1965年至1992年间接受手术治疗且病理证实为壶腹周围癌的258例患者进行了评估。对可切除组和不可切除组进行了比较。胰头癌的发生率不到患者总数的一半（47%），其中只有23%可切除。相比之下， Vater壶腹癌的发生率相似，但可切除率要高得多（86%）。因此，胰头癌是我们研究的可切除患者中的少数群体（19%）。可切除组和不可切除组的主要临床表现以及诊断前症状持续时间并无差异，因此无法通过症状预测可切除性。不可切除组中糖尿病和腹泻的发生率增加了两倍。胰头癌患者术前活检难以实施。比较胰十二指肠切除术和姑息手术，胰十二指肠切除术的并发症发生率更高（43%对13%），手术死亡率更高（17%对9%），住院时间更长（31天对20天），但胰头可切除癌和不可切除癌的中位生存时间并无统计学差异（7.5个月对5个月）。我们研究的大多数患者（可切除组为81%，不可切除组为70%）死于恶病质伴肿瘤复发。尽管胰十二指肠切除术治疗可切除胰头癌的优势受到质疑，但我们仍然建议对所有壶腹周围癌采用此手术，以避免剥夺偶尔患有胰腺癌的患者的长期生存机会，以及错过一些被误诊为其他更有利的壶腹周围癌患者的治愈机会。
