壶腹部肿瘤局部切除术式的改进

Modified local excision of ampullary tumor

目的探讨改进的壶腹部肿瘤局部切除术的可行性及效果。方法对壶腹部肿瘤局部切除术式进行改进,并对2006年至2013年18例行改进型壶腹部肿瘤局部切除术的患者(6例为绒毛状腺瘤,12例为高分化腺癌,且高龄、周身情况不能耐受胰十二指肠切除术)及15例同期手术条件相近的施行经典壶腹部肿瘤局部切除术式的壶腹部腺癌患者治疗效果进行回顾性分析,所有患者均签署知情同意书,符合医学伦理学规定。采用SPSS17.0统计软件对数据进行分析,术后住院时间比较采用t检验,其他采用χ2检验及Fisher精确概率法,生存率计算及比较分别采用Kaplan-Meier法、Fisher精确概率法,以P<0.05差异有统计学意义。结果围手术期33例患者无死亡,改进型局部切除术式组与经典局部切除术式组相比较:术后平均住院日分别为(7.6±1.7)d和(11.7±3.3)d,(t=4.444,P<0.05),并发症发生率分别为11.1%(2/18)和46.7%(7/15),(P<0.05)。6例良性肿瘤者1、5年生存率均为100%,恶性肿瘤者改进局部切除术式组与经典局部切除术式组1、3、5年生存率分别为91.7%、53.5%、0和86.7%、51.1%、27.2%,(P>0.05)。结论严格掌握适应证,改进的壶腹部肿瘤局部切除术与经典的局部切除术相比,术后生存率无显著性差异,术后住院时间及并发症发生率却显著低于后者,是治疗壶腹部肿瘤首选的局部切除术式。

Objective To explore the feasibility and curative effect of modified local excision of ampullary tumor.Methods From 2006 to 2013,a retrospective study was conducted in 33 patients with ampullary tumor,including 18 patients （6 cases of villous adenoma,12 cases of differentiated adenocarcinoma ; all the patients could not tolerate duodenopancreatectomy） who underwent modified local excision of ampullary tumor and 15 patients （15 cases of well differentiated adenocarcinoma; all the patients could not tolerate duodenopancreatectomy）who received classical local ampullectomy.Clinical data were analyzed using SPSS17.0 software.Postoperative stay in hospital was compared with Student＇s t test and other comparisons done by the chi-square test and Fisher＇s exact test.The survival rate of the patients were estimated using the Kaplan-Meier method and Fisher ＇s exact test.P ＜ 0.05 was considered statistically significant.Results There was no postoperative death in the 33 patients.The postoperative stay in hospital was （7.6 ± 1.7） days and （11.7 ± 3.3） days in modified local ampullectomy group and classical local ampullectomy group respectively （t =4.444,P ＜ 0.05）.The rate of complications was 11.1％ （2/18） and 46.7％ （7/15）in the modified local ampullectomy group and the classical local ampullectomy group respectively（P ＜ 0.05）.The 1-and 5-year survival rates of the 6 patients with villous adenoma were 100％,the 1-,3-and 5-year survival rates of the 12 patients with well-differentiated adenocarcinoma were 91.7％,53.5％,0 and 86.7％,51.1％,27.2％ in the modified local ampullectomy group and the classical local ampullectomy group respectively （P ＞ 0.05）.Conclusions If the operative indications are strictly followed,no significant difference might be observed in survival rates between the modified local excision of ampullary carcinoma and the classical one.However,compared with the classical local excision of ampullary carcinoma,modified local excision of ampullary carcinoma has a significant decrease in postoperative hospital stay and the rate of complications.Modified local excision might be a preferred operative procedure for the treatment of ampullary carcinoma.