壶腹周围癌局部扩大切除术

Extended local excision of ampullary carcinoma

目的 :探讨壶腹周围癌的局部切除术的改进方法。方法 :对 4例壶腹腺癌和十二指肠乳头腺癌实施局部扩大切除术。将部分十二指肠降段、胆胰管远段、局部 1cm厚度的胰腺组织连同壶腹周围癌一并切除。关闭十二指肠两断端 ,将近段空肠分别与胆胰管、胰头断面和十二指肠上部吻合。结果 :标本切缘均无癌组织 ;术后胰瘘 1例 ,经保守治疗后痊愈 ;术后 4～ 2 4个月随访无复发及其他并发症发生。结论 :该术式操作简单 ,对早期壶腹周围癌能够达到根治目的。

Objective:To modify the method of local excision of ampullary carcinoma.Methods:Four cases of adenocarcinomas of ampulla and duodenal papilla were treated with extended local excisions. Part of descending duodenum,distal portions of CBD and pancreatic duct and the local pancreatic tissue of 1 cm in thickness,together with the lesion were resected on bloc. The cut ends of the duodenum were closed. The proximal jejunum was anastomised in turns to the CBD and pancreatic duct,the cut end of the pancreatic head and the first portion of duodenum.Results:There was no cut edge carcinoma of all the samples. Pancreatic fistula occurred in one patient who recovered soon after conservative therapy. There was no recurrence and other complications by 4～24 months' follow up.Conclusion:This method is easy to manipulate and can achieve the effects of radical therapy for the early ampullary carcinoma.