摘要
目的探讨壶腹肿瘤手术方式的合理选择。方法回顾性分析北京协和医院1995年1月至2012年6月收治的238例壶腹肿瘤的临床病理资料。51例良性肿瘤患者中，行肿瘤局部切除术34例，胰十二指肠切除术17例；187例壶腹癌患者中，行壶腹局部切除术25例，胰十二指肠切除术162例。结果无论是对于壶腹癌还是良性肿瘤，与胰十二指肠切除术相比，行局部切除术者手术时间更短、术中出血量更少、住院时间更短、术后并发症发生率更低（均P〈O．05）。壶腹部良性肿瘤行局部切除术组与行胰十二指肠切除术组的术后生存时间差异无统计学意义（P=0．071，X2=2．003）。T1、T2期壶腹癌两种术式组术后生存时间差异也无统计学意义（P=0．054，X2=3．163）；但T3、T4期胰十二指肠切除术组术后生存时间明显长于局部切除术组（P=0．041，X2=6．309）。结论壶腹肿瘤对手术治疗的反应相对良好。对于良性肿瘤及T1～2期壶腹癌，局部切除可达到根治目的；而对于T3～4期壶腹癌，则应行胰十二指肠切除术。
Objective To compare the various surgical procedures commonly used to treat amp- ullary neoplasms. Methods The clinical data of 238 patients with ampullary tumor who were admitted to the Peking Union Hospital from January 1995 to June 2012 were retrospectively analyzed. There were 51 patients with benign ampullary adenomas （34 patients treated with local tumor resection, 17 patients treated with pancreaticoduodenectomy） and 187 patients with ampullary cancer （25 patients treated with ampulla local excision, 162 patients treated with pancreaticoduodenectomy）. Results For both ampullary cancer and benign tumor, the group of patients who received local excision was superi- or to the group of patients who received pancreaticoduodenectomy in operative time, blood loss, hospi- tal stay, and incidence of postoperative complications （all P^0.05）. For benign ampullary adenomas, there were no significant differences in postoperative median survival time between local resection and pancreaticoduodenectomy （P=O. 071 ,X2 =2. 003）. For stage T1 or T2 ampullary cancer, there was al- so no significant difference in the postoperative median survival time （P= 0. 054, X2 = 3. 163）. Howev- er, the postoperative median survival time of the pancreaticoduodenectomy group was significantly lon- ger than that of the local resection group for patients with stage T3 or T4 ampullary cancer （P=0. 041, 2 = 6. 309）. Conclusions Ampullary tumors are characterized by relatively good re- sponse to treatment. The results suggested that for patients with benign ampullary adenomas and stage T1 or T2 of ampullary cancer, local resection is a good surgical procedure. For patients with am- pullary cancer at more advanced stages （T3 or T4 ）, pancreaticoduodenectomy is the first choice of therapy.
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2013年第5期359-362,共4页
Chinese Journal of Hepatobiliary Surgery
基金
北京市重点学科建设项目（HKl00230446）
