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目的 探讨行壶腹部改良切除术治疗Vater壶腹部周围癌,减少非肿瘤器官切除,提高疗效的手术方法.方法 总结1995～1998年13例壶腹周围癌行扩大壶腹部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.
Objective To investigate the surgical treatment of Vater ampulla resection for Vater periampullary carcinoma and reduce non-neoplastic organ resection to improve the curative effect. Methods To summarize the experiences of radical ampulla resection in 13 cases of periampullary carcinoma from 1995 to 1998. Through the posterior lateral approach of the duodenum, the entire block of the extrahepatic biliary tract, the confluence of the biliary and pancreatic ducts, the ampulla and duodenal papilla, duodenal papilla closure, and interposition of gallbladder, pancreas and duodenum Roux-en-y anastomosis of jejunum or gallbladder and pancreatic jejunum. Results One patient died during perioperative period. One complication was cured by reoperation. Nine months after follow up in 9 cases, the longest survival was 29 months without complications. Signs of metastasis. Conclusions (1) The operation is in accordance with the anatomical relationship between the pancreatic duodenum; (2) the extent of dissection can be achieved according to the principle of tumor treatment; (3) the operation should be mastered by pancreatoduodenectomy. .