早期壶腹癌的局部切除治疗

Local resection of ampullary carcinoma at early stage

目的评估早期壶腹癌局部切除的可行性。方法回顾性分析20年间共36例术后病理证实为T1期（pT1）的壶腹癌，其中局部切除11例，胰十二指肠切除25例。对其术前和术中的诊断和分期进行评价，同时对不同手术方式的围手术期并发症及死亡率、住院时间、术后肿瘤复发及长期生存状况进行统计分析。结果与胰十二指肠切除术相比，局部切除手术操作简单，围手术期并发症发生率低（P=0．031）；但两组的术后住院时间（P=0．254）、围手术期死亡率（P=1．000）、术后无复发生存率（P=0．301）及长期生存率（P=0．289）之间相比差异均无统计学意义。结论对于早期壶腹癌来说局部切除与胰十二指肠切除的治疗效果相当，且术后并发症发生率低，适用于手术风险较大或拒绝行胰十二指肠切除术的患者。

Objective To assess the feasibility and indications of local resection as an alternative to pancreaticoduodenectomy for the treatment of early stage ampullary cancer. Methods In this study, 36 patients with an AJCC-stage pT1 ampullary carcinoma were operated on between 1989 and 2009. Among those local resection was performed in 11 cases and pancreaticoduodenectomy in 25 cases. The main outcome measures were pre- and intra- operative diagnosis and staging, postoperative morbidity and mortality, recurrence-free and overall survival. Results Ampullary cancer at early stage was difficult to be diagnosed and staged before and during operation. It was at a much lower risk to perform local resection than pancreatieoduodenectomy. Postoperative complications were significantly lower in local resection group than in pancreaticoduodenectomy group （ P = 0. 031 ） ; whereas the postoperative hospital stay （ P = 0. 254）, perioperative mortality （ P = 1. 000 ）, disease-free survival （ P = 0. 301 ） and long-term survival （ P = 0. 289 ） were not statistically different betweenthe two groups. Conclusions Since accurate diagnosis and staging of early ampullary cancer was difficult to establish perioperatively, local resection should be indicated for poor risk patients or those who refuse pancreaticoduodenectomy.