Lantone G, Pezzolla F, Lorusso D
Divisione di Chirurgia, Istituto di Ricovero e Cura a Carattere Scientifico Saverio de Bellis, Castellana Grotte, Bari.
Minerva Chir. 1994 Dec;49(12):1227-31.
The increased incidence of peri-ampullar neoplasia and the low percentage of cases in which radical surgery is possible fuel interest in the use of palliative treatment for this pathology. The authors report their 10-year experience of palliative surgery for peri-ampullar cancer and evaluate immediate and long-term results. Between January 1980 and December 1990 the authors operated 91 patients with peri-ampullar carcinoma (head of the pancreas, Vater's ampulla, terminal choledochus). Eight (9%) underwent radical surgery and 83 (91%) underwent palliative surgery. The distribution of cases according to tumour origin in the latter group was as follows: head of the pancreas 60 cases (72%); intra-pancreatic choledochus 13 (16%); Vater's ampulla 10 (12%). The most frequent symptoms were pain (70%) and jaundice (63%). The mean interval between the appearance of symptoms and diagnosis was 1 month (range: 5 days-12 months). The most frequently performed biliodigestive derivative surgery was cholecystojejunostomy (72% of cases). Complications were observed in 18% of cases. Mortality was 12%. Mean survival was 5 months (range: 2-43 months). The recent use of endoscopic techniques for the treatment of jaundice in patients with inoperable peri-ampullar carcinoma now requires prospective studies to compare these techniques with surgery.
壶腹周围肿瘤发病率的增加以及可进行根治性手术的病例比例较低，引发了人们对这种疾病采用姑息治疗的兴趣。作者报告了他们对壶腹周围癌进行姑息性手术的10年经验，并评估了近期和远期结果。1980年1月至1990年12月期间，作者对91例壶腹周围癌患者（胰腺头部、 Vater壶腹、胆总管末端）进行了手术。其中8例（9%）接受了根治性手术，83例（91%）接受了姑息性手术。后一组中根据肿瘤起源的病例分布如下：胰腺头部60例（72%）；胰内胆总管13例（16%）；Vater壶腹10例（12%）。最常见的症状是疼痛（70%）和黄疸（63%）。症状出现与诊断之间的平均间隔为1个月（范围：5天至12个月）。最常进行的胆肠改道手术是胆囊空肠吻合术（72%的病例）。18%的病例出现了并发症。死亡率为12%。平均生存期为5个月（范围：2至43个月）。目前，对于无法手术的壶腹周围癌患者，使用内镜技术治疗黄疸需要进行前瞻性研究，以将这些技术与手术进行比较。
