CARCINOMA OF THE AMPULLA OF VATER

A consecutive series of 36 Japanese patients with ampullary carcinoma who underwent a pancreatoduodenec-tomy at the Department of Surgery I, Kyushu University Hospital during the past 20 years were reviewed clinicopathologically to study prognostic factors. A univariate generalized Wilcoxon test showed that pre-operative serum carcinoembryonic antigen (CEA) concentration, venous invasion, lymphatic permeation and perineural invasion were significant parameters. A multivariate Cox regression analysis showed that venous invasion was the only significant variable. In a sequential serum CEA follow up of 10 patients, an elevation of serum CEA levels was seen to correspond to the clinical development of a recurrence in six, while a high concentration of serum CEA was not evident despite the clinical manifestation of a recurrence in two, and serum CEA levels remained within the normal limits with no evidence of a recurrence in two others. According to the death certificates of 15 patients, where an exact site of metastasis was available, 11 died from liver metastasis, three from lung metastasis and one from peritoneal dissemination. These findings suppon the theory that a histologic invasion of the venous space is an independent prognostic factor and close attention should be paid to any signs of haematogenous metastasis, such as to the liver and lung, as well as to a serial serum CEA follow up.     

右半结肠癌侵犯十二指肠的外科处理

在近１０年中对１０例右半结肠癌侵犯十二指肠者根据不同病理特点作了处理，术式包括十二指肠局部切除，穿孔修补、扩大胰十二指肠联合切除等，术后９例一期恢复，１例在处理并发症后也恢复出院。２例已生存３年以上，作者根据肿瘤浸润十二指肠程度，提出将浸润程度分为三型，Ｉ型，癌肿小范围浸润十二指肠，直径在１．５￣２ｃｍ以内，较活动；Ⅱ型，肿瘤浸润十二指肠直径大于２ｃｍ，受累部分比较固定，十二指肠周围组织可同时受累     

磁共振胆胰管成像对壶腹部肿瘤诊断的价值

目的 评价磁共振胆胰管成像对壶腹部癌的诊断价值。方法 通过总结23例壶腹部癌的MRCP及MRI影像资料。对磁共振影像诊断与病理学诊断与病理学诊断的符合率进行回顾性分析。结果 磁共振胰管成像的定位诊断率为100%，与病理诊断的符合率也达91.3%。结论 磁共振胆胰管成像是一种非介入性胆胰管成像技术，具有不需要对比剂，无创伤及图像清晰的优点，对壶腹部癌有较高的诊断价值。     

壶腹部癌局部切除术的疗效评价

目的　探讨局部切除术治疗壶腹癌的疗效及合理性。方法　对 1993～ 2 0 0 0年间 15例行壶腹癌局部切除的患者与同时期手术条件相近的行胰十二指肠切除术的 18例壶腹癌患者的治疗效果进行了回顾性对比分析。结果　局部切除术与胰十二指肠切除术两组比较 :并发症分别为 13.3%和 38.8% ,(P>0 .0 5 )。 1年内、2年内、5年内复发率分别为 2 6 .7%、5 3.3%、6 6 .7%和 0、16 .6 %、2 7.8% (P<0 .0 1)。结论　壶腹癌局部切除虽然并发症较少 ,却无法做到根治 ,有较高的复发率 ,远期疗效不佳。     

经胆总管刮取组织法诊断壶腹癌（附13例报告）

经胆总管刮取组织法诊断壶腹癌13例,11例刮取组织中腺癌9例,腺瘤伴高度不典型增生、原位癌1例,绒毛乳头状瘤样增生1例。2例疑壶腹癌者刮取未得组织。常规胆总管探查术中适时应用此法有助于诊断未经注意的壶腹癌。在疑壶腹癌病例中采用本法诊断时多能得到阳性结果,但对刮取未得组织者应改用其它方法明确诊断。刮取组织病检诊为腺癌或绒毛肿瘤时有可能遗漏隐藏的恶性病变,故仍应将其完全切除病检。     

CARCINOMA OF THE PAPILLA OF VATER

Carcinoma of the papilla of Vater was diagnosed in 18 patients during the period 1970 to 1980. In ten patients, surgical treatment was facilitated by a preoperative diagnosis based on duodenal endoscopy, biopsy, cytology and retrograde cholangiopancreatography. Of 16 patients with apparently localised disease at laparotomy, nine had pancreatoduodenectomy (Whipple's operation), three had local resection and four had biliary bypass. Six of nine patients treated by pancreatoduodenectomy are surviving for periods ranging from one to ten years, mean four years, whereas the four patients treated by biliary bypass survived for 0 to 18 months. Tumour recurred in the region of the papilla in two of three patients treated by local resection. Carcinoma of the papilla of Vater is usually localised at the time of diagnosis and prolonged survival can be achieved by pancreatoduodenectomy.