Vater壶腹肿瘤术式探讨

Study on the Modus Operandi of Ampullary Carcinoma of the Vater

目的分析Vater壶腹肿瘤三种术式疗效,提供安全、实用、简化的新术式。方法回顾分析10年间的36例患者经胰十二指肠切除术（PD）（A组9例）、局部切除术（B组16例）、节段十二指肠及胰头切除术（PHRSD）（C组11例）三种不同术式处理的疗效,判定局除切除术及PHRSD的可靠性。结果A、B、C三组平均住院分别为22、13、17天,发生手术并发症分别为5、1、2例,围手术期死亡分别为1、0、0例,术后1年、3年、5年存活率分别为A组88.9%、66.7%、33.3%;B组93.8%、75%、37.5%;C组90.9%、72.7%、36.4%。相关统计分析示：手术并发症发生率A组高于B、C组,有显著性意义（P〈0.05）,B、C组间差别无显性意义（P〉0.05）;围手术期死亡及术后1年、3年、5年存活率三组间差别无显著性意义（P〉0.05）。结论与PD相比,局部切除术及PHRSD术式治疗Vater壶腹肿瘤具有多方面优点,适合绝大部分的Vater壶腹肿瘤患者。

Objective A new safe, practical and simplified modus operandi was presented by analysis of therapeutic effect concerning with ampullary carcinoma of the Vater. Methods A retrospective analysis of the clinical data was made on 36 cases of ampullary carcinoma of the Vater admitted from Mar. 1995 to Dec. 2005. In order to assess the reliability of PHRSD and local resection of ampullary carcinoma of the Vater, comparison was made on treatment between every 2 of 3 different modus operandi including pancreaticduodenectomy（PD or Group A 9 cases）, local resection of ampullary carcinoma of the Vater （Group B 16 cases） and pancreatic-head-region-segment-duodenectomy（PHRSD or Group C 11 cases）. Results There were 9 patients in the Group A with the mean hospital time 22 days, complication 5 cases, post operative mortality 1 case, the survival rate of 1,3,5 years 88.9%, 66.7% and 33.3% respectively, comparing with 13 days in hospital, 1 cases of complication, zero post operative mortality, the survival rate of 1,3,5 years 93.8%, 75% and 37.5% respectively in the Group B, with 17 days in hospital, 2 cases of complication, zero post operative mortality, the survival rate of 1,3,5 years 90.9%, 72.7% and 36.4% respectively in the Group C. The incidence rate of complication in Group A is significantly higher than that in the other 2 groups （P〈O. 05）, while the differences of complication case, post operative mortality and survival rate of 1,3,5 years among 3 groups appeared insignificant （P〉O. 05）. Conclusion Compared with PD, local resection and PHRSD, because of the characteristic of little trauma, less complication, good effect as well as safe and simple operative way, seem suitable to most of patients suffered from ampullary carcinoma of the Vater, especially to the patient with old age, severe jaundice and bad general condition.