壶腹部肿瘤局部切除的临床与病理探讨

目的：探讨局部切除治疗壶腹部肿瘤的疗效。方法：对本院1994年2月～2006年3月27例实施了局部切除术的壶腹部肿瘤患者进行分析。结果：手术均获得成功，最终病理诊断为16例绒毛状腺瘤，4例管状腺瘤，1例神经鞘瘤；术中冰冻对检查腺癌的敏感性和特异性分别为25％和100％．阳性预测值和阴性预测值分别为100％和84％；患者平均住院7.9天，术后7例（26％）出现并发症，无围手术期和住院期间死亡病例；良性肿瘤的5年、10年复发概率分别为8％，17％，恶性肿瘤的5年、10年复发概率分别为19％，59％。5例患者在随访期死亡，2例死于腺癌复发，3例死于其他疾病。恶性肿瘤的5年，10年总体生存率为49％，26％．结论：对于壶腹部良性肿瘤局部切除是首选的方式而对于壶腹部恶性肿瘤应采用Whipple手术，局部切除适合于难以耐受手术者。

Clinicopathologic Studies on Local Excision of Ampullary Tumors

Objective: To evaluate the curative effect of local excision of tumors of the ampulla of Vater. Methods: Retrospective analysis was conducted for local excision performed in 27 patients with ampullary tumors during the period from February 1994 to March 2004. Results: All of the surgeries were successful. The results of the final pathological diagnosis were as follows: 16 patients suffered villous adenoma, 4 had canalicular adenoma and 1 had myoschwannoma. The sensitivity and specificity of intraoperative detection of the adenoma were 25% and 100%, respectively. The positive and negative predictive values were 100% and 84%, respectively. The mean hospital stay was 7.9 days. After surgery, complications were found in 7 cases (accounting for 26%), but no deaths occurred during the perioperative period or the duration of the hospital stay. The probability of recurrence of the benign tumors was 8% within 5 years and 17% within 10 years. For the malignancies the probability of recurrence was 19% within 5 years and 59% within 10 years. Five patients died during follow-up: 2 died of recurrence of the adenoma and 3 died of other diseases. The 5- and 10-year survival rates for malignant tumors were 49% and 26%, respectively. Conclusions: Local resection is a good treatment method for benign ampullary tumors, and local resection of malignant ampullary tumors is an effective palliative treatment for patients unfit for the Whipple procedure.