el-Ghazzawy A G, Wade T P, Virgo K S, Johnson F E
Department of Surgery, John Cochran Department of Veterans Affairs Medical Center, St. Louis, Missouri, USA.
Am Surg. 1995 Jul;61(7):607-11.
A total of 64 resections, 24 operative bypasses and 35 nonoperative biliary intubations, were performed for ampullary carcinoma in U.S. Dept. of Veterans Affairs hospitals from 1987 to 1991. Mean survival after resection was 702 days, significantly higher (ANOVA, P < or = 0.005) than that after bypass (345 days) or intubation (385 days). Operative mortality rates were similar: resection or intubation = 14%, bypass = 12%. Operative (30-day) mortality was zero in four local resections, 10% in 51 Whipples and 44% in nine total pancreatectomies. TNM staging was available for 74 patients, and mean survival after resection exceeded 2 years in 34 patients with Stage I-II (localized) cancers, was 532 days in 10 patients with Stage III (regional nodes +) and 77 days in two patients with Stage IV (metastatic) disease. However, mean survival without resection was 498 days in 14 patients with localized cancer, 634 days in two patients with regional and 215 days in 11 patients with distant metastases. Resection clearly increased survival only for Stage I cancers (P < or = 0.02). Predicted 5-year survival rates by stage after resection were: I-II = 21%, III < 10%, IV = 0%. Complications were recorded in 29 per cent of resected patients, with sepsis the most common (21% of resections). Both sepsis and GI bleeding significantly decreased mean survival (P < or = 0.05, ANOVA), but pneumonia, pancreatic fistula, or wound problems did not. Ampullary cancer is a favorable subtype of peri-ampullary cancers, but prolonged survival is also seen without resection and may be largely limited to tumors that do not involve regional nodes.
1987年至1991年期间，美国退伍军人事务部医院针对壶腹癌共实施了64例切除术、24例手术搭桥术和35例非手术性胆管插管术。切除术后的平均生存期为702天，显著高于（方差分析，P≤0.005）搭桥术后（345天）或插管术后（385天）的生存期。手术死亡率相似：切除术或插管术为14%，搭桥术为12%。4例局部切除术的手术（30天）死亡率为零，51例惠普尔手术的死亡率为10%，9例全胰切除术的死亡率为44%。74例患者有TNM分期数据，34例I-II期（局限性）癌症患者切除术后的平均生存期超过2年，10例III期（区域淋巴结阳性）患者为532天，2例IV期（转移性）疾病患者为77天。然而，14例局限性癌症患者未切除术后的平均生存期为498天，2例区域淋巴结转移患者为634天，11例远处转移患者为215天。切除仅对I期癌症的生存期有明显提高（P≤0.02）。切除术后各阶段的预测5年生存率为：I-II期=21%，III期<10%，IV期=0%。29%的切除患者记录有并发症，其中败血症最为常见（占切除术的21%）。败血症和胃肠道出血均显著降低了平均生存期（P≤0.05，方差分析），但肺炎、胰瘘或伤口问题则没有。壶腹癌是壶腹周围癌的一种预后较好的亚型，但未切除的情况下也可见生存期延长，且可能主要限于不涉及区域淋巴结的肿瘤。
