胰十二指肠切除术治疗胰头和壶腹部癌（230例分析）

为了解胰十二指肠切除术治疗胰头和壶腹部癌的效果。我们分析了230例胰头和壶腹部癌的主要表现，辅助捡查，手术并发症．手术死亡率．调查术后生存情况及影响病人长期存活的因素。结果发现病人出现黄疸909％，腹痛56．1％，发热32．6％．白陶土样大便13．5％。B超、CT和ERCP检查准确率分别为68．3％、79．3％和66．6％。手术并发症72例（313％)，手术死亡20例(87％)。手术并发症与出血量，营养状况，手术时间和手术操作有关系。术后1年，3年和5年存活率分别为46．9％．17．4％和5．2％，肿瘤直径，淋巴结转移和切缘状态是影响病人术后生存的因素．而肿瘤分化程度和病人年龄对生存率无明显影响。结果提示：胰头和壶腹部癌临床表现有多样性，B超和CT等辅助捡查有局限性，手术有并发症和死亡率高的危险性，5年生存率低等特性．其手术治疗远近期效果都不理想。     

胰十二指肠切除术治疗胰头和壶部癌230例分析

目的：了解胰十二指肠切除术治疗胰头和壶腹部癌的效果和影响病人生存的因素。方法：分析２３０例胰头和壶腹部癌的主要表现、辅助检查、手术并发症、手术死亡率，调查术后生存情况及影响病人长期生存的因素。结果：本组病人出现黄疸９０．９％，腹痛５６．１％。手术并发症７２例（３１．３％），死亡２０例（８．７％）。术后１、３、５年存活率分别为４６．７％，１７．４％和５２％。肿瘤直径、淋巴结转移和切缘状态是影响病人术     

胰十二指肠切除术治疗壶腹部癌和胰头癌临床分析

壶腹周围癌是指胆胰壶腹周围2cm范围内的恶性肿瘤，包括壶腹部癌（胆总管末端壶腹癌和十二指肠乳头癌）、胰头癌及十二指肠降段的恶性肿瘤．胰十二指肠切除术是治疗壶腹周围癌的主要方式，但该手术对于壶腹部癌和胰头癌的疗效有所差别．将我院近7年收治病例的情况报道并分析如下。     

对壶腹部癌行保留十二指肠升部的胰头十二指肠切除术

对46例壶腹癌患者采取保留十二指肠升部的胰头十二指肠切除术,取得满意效果,现总结如下.     

胰头十二指肠切除术71例分析

目的探讨如何提高胰头壶腹部恶性肿瘤的手术切除率和手术成功率。方法对1981～1997年收治的71例胰头十二指肠切除术患者的术后并发症、病死率及术前术中诊断情况进行分析。结果71例中恶性肿瘤61例,良性疾病10例（14．2％）,有并发症24例（33．8％）,死亡8例（11．2％）。结论要提高胰头壶腹恶性肿瘤的手术切除率和治愈率,关键是早期诊断、妥善的围手术期处理和精湛的手术技巧。     

胰十二指肠切除术治疗胰头及壶腹部癌（附97例临床分析）

为提高胰头及壶腹部癌的疗效，总结９７例胰十二指肠切除术（ＰＤ）治疗胰头及壶腹部癌的诊治经验。癌肿切除率为３４．４％，手术并发症发生率为３８．４％，手术死亡率为１１．３％，术后１、３和５年生存率分别为６８．８％、４３．１％和３０．０％。认为要提高本病早期诊断率，必须对可疑高危病人提高警惕，首选Ｂ超检查，Ｂ超和ＥＲＣＰ两项联合检查可提高本病早期诊断。     

壶腹部周围癌胰头十二指肠切除的手术配合

胰头十二指肠切除术是腹部最复杂的手术之一，手术切除范围包括胰头及胰沟部、胃窦、十二指肠全部及空肠上段的一部分，胆总管下段及局部淋巴结。因手术范围大，易出血，时间长，吻合口多，对病人侵袭广，易出现并发症等特点。我院自1998年1月～2003年1月已为50例患行此手术，效果较满意。本就手术配合谈谈体会，现报告如下：     

胰十二指肠切除术治疗胰头和壶腹周围癌

胰十二指肠切除术治疗胰头和壶腹周围癌上海市金山县中心医院外科（２０１５００）胡军，金庆丰胰十二指肠切除术是治疗可切除胰头和壶腹周围癌的首选手术方式。近年来一些文献报告手术并发症和死亡率有所降低，但仍偏高。我们自１９７７年１月～１９９１年１２月，对３７...     

改良胰十二指肠切除术治疗16例胰头及壶腹周围癌疗效观察

对16例可切除胰头及壶腹周围癌行保留幽门的改良胰十二指肠切除术进行分析。结果表明，与传统术式相比，改良胰十二指肠切除术不仅缩短了手术时间，而且还改善了病人术后营养状况，减少术后并发症的发生。同时5年和3年生存率分别为18．7％和31．2％，与传统方法相近。因此，对肿瘤较小的胰头及壶腹周围癌，宜首选保留幽门的改良胰十二指肠切除术。     

胰十二指肠切除术治疗胰头及壶腹周围癌41例体会

目的：探讨如何减少胰十二指肠切除术后并发症及提高胰头及壶腹周围癌的疗效。方法：总结我院41例胰头及壶腹周围癌患者行胰十二指肠切除术治疗的经验。结果：癌肿切除率为17.7％，手术并发症发生率为26．8％．手术死亡率为14．6％。而1990年后仅发生2例且无胆、胰瘘发生，亦无死亡。结论：应用胰肠、胆肠吻合口处双管减压引流，防止了术后胰、胆瘘的发生，是降低并发症及死亡率的重要手段。     

Signet-Ring Cell Carcinoma of the Ampulla of Vater: Report of a Case

An 83-year-old man was admitted to our hospital complaining of general fatigue, fever, and obstructive jaundice. Percutaneous transhepatic bile duct drainage was performed. Gastroduodenal fiberscopy revealed carcinoma of the ampulla of Vater, and early gastric cancer was suspected. A pancreatoduodenectomy with lymph node dissection was performed. Although a biopsy specimen from the gastric lesion was suspected to be well-differentiated adenocarcinoma, no cancerous lesion was found in a specimen resected from the stomach. The histopathologic findings of the ampullary lesion were compatible with a diagnosis of signet-ring cell carcinoma. This is a rare lesion, and a review of the literature revealed only three previous similar cases. Received: May 1, 2001 / Accepted: March 5, 2002 RID="*" ID="*" Reprint requests to: N. Eriguchi (address 1)     

Vater壶腹结石嵌顿的术中处理

目的探讨Vater壶腹结石嵌顿的术中处理技巧。方法回顾性分析2003年8月~2006年12月共35例此类病人的临床资料。30例经胆总管下段切开取石,2例行经十二指肠Odd i括约肌切开取石,3例行胆道镜下微爆破碎石仪碎石术。结果所有手术均成功,无一例病人出现大出血、胆漏、肠漏等严重的并发症。平均随访18个月,均无腹痛及胆总管结石复发。结论Vater壶腹嵌顿结石的处理应根据病人病情及医疗条件抉择,在剖腹术中采取经胆总管下段切开取石较为简便和安全。     

Pancreatic invasion is a prognostic indicator after radical resection for carcinoma of the ampulla of Vater

Sixty-three patients who had undergone pancreatoduodenectomy for carcinoma of the ampulla of Vater were analyzed with respect to tumor extent and prognosis. The postoperative mortality rate was 3% and overall survival rates 3 and 5 years after surgery were 55% and 46%, respectively. pTNM stage did not reflect prognosis after resection in patients at stages 2 and 3, while pancreatic invasion and regional lymph node metastasis clearly reflected prognosis after resection. Of the 26 patients who had no pancreatic invasion, regional lymph node metastasis was seen in only 19%, whereas of the 37 patients with pancreatic invasion, 62% exhibited lymph node metastasis. These factors were significantly correlated (P<0.001). Pancreatic invasion appeared to be an indirect indicator of regional lymph node metastasis. We conclude that, to improve prognosis for patients with pancreatic invasion, extended resection including extended lymphadenectomy, is a preferable additional procedure.     

胰十二指肠切除术对胰头癌患者CD4~+CD25~+调节性T细胞的影响及临床意义

目的研究胰头癌患者外周血中CD4+CD25+调节性T细胞(Treg)比例及其在手术前、后的变化趋势。方法采用流式细胞仪检测胰头癌患者及正常对照组外周血中CD4+CD25+调节性T细胞的数量,同时监测CD4+/CD8+比值,并进行手术前、后的比较。结果胰头癌患者术前外周血中CD4+CD25+和CD4+CD25highTreg所占比例较正常对照组高(P<0.05),术后则出现不同程度下降,以术后第3天下降最明显(P<0.01,P<0.05);胰头癌患者术后CA19-9水平低于术前,以术后第14天下降明显(P<0.05)。CD4+CD25highTreg与CA19-9的变化趋势大致相同。胰头癌患者术前CD4+/CD8+比值比正常对照组低(P<0.05),手术后进一步降低,于手术后第7天达最低(P<0.05)。结论胰十二指肠切除术可能有助于机体抗肿瘤免疫的恢复,胰头癌患者围手术期可作为免疫干预的重要窗口期,CD4+CD25+调节性T细胞可作为免疫干预的靶点。     

Carcinoid of the Ampulla of Vater-Report of two Cases

Carcinoid of the ampulla of Vater is extremely rare, accounting for less than 0.3% of all gastro-intestinal carcinoids. To our knowledge, only 80 cases of ampullary carcinoid have been reported in the literature to date. Ampullary carcinoid is more commonly presented with jaundice or upper abdominal discomfort and diagnosis is more often made postoperatively due to submucosal spread of the tumour. As metastatic potential cannot be predicted by tumour size, Whipple pancreatoduodenectomy rather than local excision is considered to be the treatment of choice. We report here two cases of ampullary carcinoid treated in our department.     

Patterns and Predictors of Failure after Curative Resections of Carcinoma of the Ampulla of Vater

Background:Curative resection does not always equate with long-term survival. The aim was to identify patterns and predictors of failure and independent factors of prognosis after curative resection.Methods:Sixty-six patients with ampullary carcinoma who underwent surgical intervention were reviewed. Fifty-nine patients underwent pancreaticoduodenectomy. Cox regression analysis, log-rank test, Fisher exact test, or ² test was used.Results:No patient died as a result of surgery; major complications occurred in three, and the 5-year survival rate after curative resection (n = 55) was 52.6%. Significant survival predictors were preoperative serum carcinoembryonic antigen level; gross tumor appearance; tumor, node, and tumor node metastasis stage; and microscopic lymphatic vessel and venous invasion in the primary tumor. Multivariate analysis demonstrated that lymphatic vessel invasion, tumor, and tumor node metastasis stage were significant independent prognostic factors. No patient experienced locoregional failure alone; all 24 relapsed patients had distant failure, and six of them had both. The liver was the most frequent metastatic organ, followed by nodes, peritoneum, lung, and bone. The carcinoembryonic antigen and carbohydrate antigen levels and lymphatic vessel and venous invasion were significant predictors of distant failure, and the mean time to relapse was 13 (range, 0.7–33) months.Conclusions:Curative resection is associated with significant survival; however, effective systemic adjuvant therapy is needed to prevent distant failure for patients with elevated carcinoembryonic antigen and carbohydrate antigen levels or positive lymphatic vessel or venous invasion. A 3-year follow-up period would be necessary to document relapses.     

CT引导经皮穿刺^125I粒子植入治疗胰头癌

目的探讨CT引导经皮穿刺^125I粒子植入治疗胰头癌的价值。方法2005年10月～2012年8月,16例胰头癌在CT引导下采用经皮经胃（10例）或经皮经肝经文氏孔（6例）穿刺胰头癌植入^125I粒子,术后1、3个月进行cT随访。结果16例^125I粒子植人全部成功,植入粒子12～38颗,平均23．5颗,放射性粒子分布良好,间距均〈1．5cm。穿刺过程中无一例并发症发生。6例出现一过性血淀粉酶升高120～195U／L（正常值为25～100U／L））,未经特殊处理2—3d后转为正常,无胰漏发生。术后发热4例,体温均〈38．0℃,未经处理第2天恢复正常。未发生胃肠道漏,经肝脏穿刺患者未出现肝功能异常,穿刺针道无肿瘤种植性转移。右上腹和腰背部疼痛缓解（术后VAS评分3～7分,平均4．5分）,患者食欲增加。术后3个月患者均生存;术后1、3个月行上腹部增强扫描,3个月时肿瘤CR2例（12．5％）,PR10例（62．5％）,SD3例（18．8％）,PD1例（6．2％）。结论对晚期胰头癌失去手术机会者,胰头癌合并有全身性疾病不能承受手术治疗者,以及不能承受化疗和体外放射治疗者,经皮穿刺^125I粒子植入为一种有效的治疗方法。     

扩大Vater壶腹部切除的根治术治疗壶腹部肿瘤

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。