小壶腹周围癌的局部切除

Local resection for small peri-ampullar carcinoma

目的 介绍一种小壶腹周围癌的有效、安全、简便的局部切除方法。方法 切开胆总管中段 ,向远端插入导尿管 ,以了解肿瘤侵犯胆总管末端的程度。切开十二指肠前壁 ,距肿瘤 2cm处电刀环形切除 ,边切边缝合十二指肠和胆总管粘膜。将胃肠减压管下拉到十二指肠降部 ,鼻饲营养管末端置于空肠中。结果 1 2例手术后病理报告切缘均无癌残留 ,无术后并发症 ,痊愈。 7例随诊1 2～ 57个月 ,均健在。住院时间及诊疗费用仅为whipple手术的 50 %左右。 结论 对于小于 2cm的壶腹周围癌 ,尤其是高龄或有并发症的患者 ,该术式是一种安全、有效的治疗方法。

Objective To introduce an effective, safe and simple local resection method for small peri ampullar carcinoma. Methods After an incision on the middle part of the common bile duct (CBD), a urethral catheter was put into its distal part to understand the invasive degree of the tumor to the distal end of the CBD. The anterior wall of the duodenum was incised, and the surrounding tissues within 2 cm of the tumor were resected circularly along with the tumor. Mucous membrane of the duodenum and the CBD was sutured together soon after the cutting. The gastrointestinal decompression tube was pulled deep into the descending part of the duodenum, and the end of the nasal feeding tube was put in the jejunum.Results The pathological report of the 12 cases in our group showed that the entire incisive margin had no residual of cancer. No post operative complications occurred, and the patients discharged from the hospital with recovery. After 12～75 months follow up, 7 cases were alive and healthy. The hospitalization period and cost were only 50% of that of Whipple's procedure. Conclusion To those peri ampullar carcinoma which is no more than 2 cm in diameter, particularly those elder or with complications, local resection is a safe and effective curative method.