• 四川大學(xué)華西醫(yī)院膽道外科(成都 610041);

目的 探討原發(fā)性十二指腸乳頭癌的診斷及外科治療方法。方法 回顧性分析2002年1月至2008年12月期間經(jīng)手術(shù)治療的54例原發(fā)性十二指腸乳頭癌患者的臨床資料。結(jié)果 行纖維十二指腸鏡檢查37例，行ERCP檢查35例，準(zhǔn)確率均為100%。44例行胰十二指腸切除術(shù)，10例行姑息性減黃手術(shù)。手術(shù)均順利完成，術(shù)后出現(xiàn)胰漏6例,腹腔及切口感染2例,出血2例,肺部感染1例，漏膽1例。患者術(shù)后1、3及5 年的累積生存率分別為68%、50%及29%。結(jié)論 纖維十二指腸鏡及ERCP是診斷十二指腸乳頭腫瘤最有效的檢查方法, 早期診斷、早期選擇合理的根治性切除手術(shù)是治療的關(guān)鍵。

引用本文： 淦宇,李寧,魯穩(wěn)柱. 原發(fā)性十二指腸乳頭癌的診斷及治療. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(12): 1299-1301. doi: 復(fù)制

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2. 成東華摘譯. 小腸腫瘤的TNM分期 [J]. 中國實(shí)用外科雜志, 2006; 26(12): 927.
3. Klempnauer J, Ridder GJ, Pichlmayr R. Prognostic factors after resection of ampullary carcinoma: multivariate survival analysis in comparison with ductal cancer of the pancreatic head [J]. Br J Surg, 1995; 82(12): 1686-1691.
4. Howe JR, Klimstra DS, Moccia RD, et al. Factors predictive of survival in ampullary carcinoma [J]. Ann Surg, 1998; 228(1): 87-94.
5. Beger HG, Treitschke F, Gansauge F， et al． Tumor of the ampulla of Vater: experience with local or radical resection in 171 consecutively treated patients [J]. Arch Surg, 1999; 134(5): 526-532.
6. Talamini MA, Moesinger RC, Pitt HA, et al． Adenocarcinoma of the ampulla of Vater. A 28-year experience [J]. Ann Surg, 1997; 225(5): 590-599.
7. Duffy JP, Hines OJ, Liu JH, et al. Improved survival for adenocarcinoma of the ampulla of Vater: fifty-five consecutive resections [J]． Arch Surg, 2003; 138(9): 941-948.
8. Sperti C, Pasquali C, Piccoli A, et al. Radical resection for ampullary carcinoma: long-term results [J]. Br J Surg, 1994; 81(5): 668-671.
9. Alexakis N, Halloran C, Raraty M, et al. Current standards of surgery for pancreatic cancer [J]. Br J Surg, 2004; 91(11): 1410-1427.
10. Yamaguchi K, Chijiwa K, Shimizu S, et al. Comparison of endoscopic retrograde and magnetic resonance cholangiopancreatography in the surgical diagnosis of pancreatic diseases [J]. Am J Surg, 1998; 175(3): 203-208.
11. Ito K, Fujita N, Noda Y, et al． Preoperative evaluation of ampullary neoplasm with EUS and transpapillary intraductal US: a prospective and histopathologically controlled study [J]. Gastrointest Endosc, 2007; 66(4): 740-747.
12. Sewnath ME, Karsten TM, Prins MH, et al. A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice [J]. Ann Surg, 2002; 236(1): 17-27.
13. Lai EC, Doty JE, Irving C, et al. Primary adenocarcinoma of the duodenum: analysis of survival [J]. World J Surg, 1988; 12(5): 695-699.
14. Joesting DR, Beart RW Jr, van Heerden JA, et al. Improving survival in adenocarcinoma of the duodenum [J]. Am J Surg, 1981; 141(2): 228-231.
  1. 1. Allema JH, Reinders ME, van Gulik TM, et al. Results of pancreaticoduodenectomy for ampullary carcinoma and analysis of prognostic factors for survival [J]. Surgery, 1995; 117(3): 247-253.
  2. 2. 成東華摘譯. 小腸腫瘤的TNM分期 [J]. 中國實(shí)用外科雜志, 2006; 26(12): 927.
  3. 3. Klempnauer J, Ridder GJ, Pichlmayr R. Prognostic factors after resection of ampullary carcinoma: multivariate survival analysis in comparison with ductal cancer of the pancreatic head [J]. Br J Surg, 1995; 82(12): 1686-1691.
  4. 4. Howe JR, Klimstra DS, Moccia RD, et al. Factors predictive of survival in ampullary carcinoma [J]. Ann Surg, 1998; 228(1): 87-94.
  5. 5. Beger HG, Treitschke F, Gansauge F， et al． Tumor of the ampulla of Vater: experience with local or radical resection in 171 consecutively treated patients [J]. Arch Surg, 1999; 134(5): 526-532.
  6. 6. Talamini MA, Moesinger RC, Pitt HA, et al． Adenocarcinoma of the ampulla of Vater. A 28-year experience [J]. Ann Surg, 1997; 225(5): 590-599.
  7. 7. Duffy JP, Hines OJ, Liu JH, et al. Improved survival for adenocarcinoma of the ampulla of Vater: fifty-five consecutive resections [J]． Arch Surg, 2003; 138(9): 941-948.
  8. 8. Sperti C, Pasquali C, Piccoli A, et al. Radical resection for ampullary carcinoma: long-term results [J]. Br J Surg, 1994; 81(5): 668-671.
  9. 9. Alexakis N, Halloran C, Raraty M, et al. Current standards of surgery for pancreatic cancer [J]. Br J Surg, 2004; 91(11): 1410-1427.
  10. 10. Yamaguchi K, Chijiwa K, Shimizu S, et al. Comparison of endoscopic retrograde and magnetic resonance cholangiopancreatography in the surgical diagnosis of pancreatic diseases [J]. Am J Surg, 1998; 175(3): 203-208.
  11. 11. Ito K, Fujita N, Noda Y, et al． Preoperative evaluation of ampullary neoplasm with EUS and transpapillary intraductal US: a prospective and histopathologically controlled study [J]. Gastrointest Endosc, 2007; 66(4): 740-747.
  12. 12. Sewnath ME, Karsten TM, Prins MH, et al. A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice [J]. Ann Surg, 2002; 236(1): 17-27.
  13. 13. Lai EC, Doty JE, Irving C, et al. Primary adenocarcinoma of the duodenum: analysis of survival [J]. World J Surg, 1988; 12(5): 695-699.
  14. 14. Joesting DR, Beart RW Jr, van Heerden JA, et al. Improving survival in adenocarcinoma of the duodenum [J]. Am J Surg, 1981; 141(2): 228-231.