壶腹周围癌包括壶腹癌,胆总管下段癌、十二指肠乳头癌和胰头癌。这些部位恶性肿瘤的临床表现相似,术前鉴别困难,有时术中也难作出判断。近年来本病发病率逐渐上升。本文就壶腹周围癌的诊断和外科治疗的现状和进展加以讨论。一、临床诊断(一)早期临床表现黄疸是壶腹周围癌最突出的症状,但早期症状不明显。黄疸作为初发症状的仅占胰头癌病人的15～20%。肿瘤缓慢生长过程中,胆道通过代偿性适应,临床上可不出现黄疸,而出现非特异性的消化道症状,如腹痛、腹胀纳差等。在黄疸不是初发症状时,出现黄疸距初发症状出现在胰头癌病人平均相隔3个月,最长为22个月;(?)壶腹癌 Periampullary cancer includes ampullary carcinoma, lower common bile duct cancer, duodenal papillary carcinoma and pancreatic head cancer. The clinical manifestations of malignant tumors at these sites are similar, and it is difficult to identify preoperatively, and it is sometimes difficult to make judgments during surgery. In recent years, the incidence of the disease has gradually increased. This article discusses the status and development of the diagnosis and surgical treatment of periampullary cancer. First, the clinical diagnosis (a) early clinical manifestations of jaundice is the most prominent symptoms of periampullary cancer, but the early symptoms are not obvious. Astragalus, as the initial symptom, only accounts for 15 to 20% of patients with pancreatic cancer. In the process of slow tumor growth, the biliary tract can be compensated by compensatory adaptation, clinically there may be no jaundice, and non-specific gastrointestinal symptoms such as abdominal pain, abdominal distension and anorexia occur. When the jaundice is not the initial symptom, the occurrence of jaundice from the initial symptoms of pancreatic cancer in patients with an average of 3 months apart, the longest 22 months; (?) ampullary cancer