扩大Vater壶腹部切除的根治术治疗壶腹部肿瘤

Redical ampuUectomy for the treatment of carcinoma ampulla of Vater

目的 探讨Vater壶腹部肿瘤行壶腹部扩大切除的根治性手术的方法,以减少非肿瘤器官切除,并符合肿瘤治疗原则。方法 总结1995-1998年手术切除的根治术的经验。经十二指肠后外侧入路,整块切除肝外胆道、胆胰管汇合部,壶腹部及十二指肠乳头,十二指肠乳头封闭术。胆、胰、十二指肠间置空肠或胆、胰空肠Roux-en-Y吻合术。结果 围手术期死亡1例。并发症1例经再手术治愈。随访术后半年以上病人9例,最长生存29个月,无并发症及转移征象。结论（1）该术式符合胰十二指肠解剖关系;（2）按肿瘤治疗原则能达到广泛程度清扫;（3）初行该术式者应掌握胰十二指肠切除术。

Objective To inuestigate the method of radical ampullectomy in the treatment of carcinoma ampulla of Vater, which can reduce the extent of excision of the noninfiltrated organs and still accord with the therapeutic principle of malignant tumor. Methods The en bloc extrahepatic biliary tract, confluence of pancreatic and biliary duct, ampulla of Vater and duodenal papilla was excised by posterolateral route through the postenor wall of duodenum (Kocher' s incision) . The defect of duodenal was closed. Subsequently, jejunum interposed choledocho - pancreato - duodenostomy of Roux - en - Y choledocho - pancreato - duodenostomy was performed. Results Of 38 cases of carcinoma of ampulla of Vater and carcinoma of the head of pancreas, 13 cases underwent radical ampullectomy from 1995 to 1998. One patient died postoperatively. One patient had complication and was cured by re - operation. The longest survival period is 29 months without complication and metastasis. Conclusions (1)Redical ampullectomy accords with the anatomic structure of pancreatoduodenum. (2)The resected range of lymph nodes is wide enough to follow the therapeutic principle of malignant tumor. (3)0perater who performes this operation for the first time must grasp beforehand the technique of pan-creatoduodenectomy.