局部切除术在Vater壶腹肿瘤治疗中的地位

Local resection of ampullary tumors

Vater壶腹肿瘤比较少见,手术方式的选择目前仍存争议.局部切除术与胰十二指肠切除术相比,手术操作相对简单,手术死亡率和并发症率相对较低,安全性较高,但复发率也较高.近年来,在大多数有经验的医学中心whipple术的手术死亡率已明显下降,且壶腹肿瘤术前、术中准确的组织学诊断及分期常有困难,结果常不可靠.因此,局部切除的指征应严格掌握,仅限于高危人群或拒绝大手术的患者.

Ampullary tumors are rare. Their appropriate treatment is still contraversial. Local resection of ampullary tumors is a relatively simple procedure with a lower operative morbidity and mortality rate than pancreatoduodenectomy. However, the mortality of Whipple procedure has significantly decreased in the past two decades, as reported in many medical centers. Since accurate preoperative histological diagnosis and staging of the tumors are often difficult and inconclusive, local resection should be limited in those with a poor health status, or in those refusing major operations, although it is considered an alternative in patients with a high co-morbidity.