ObjectiveTo evaluate the imaging examination in the diagnosis of periampullary carcinoma. MethodsA retrospective analysis of 125 patients with pathologically proven periampullary carcinomas enrolled in Zhongshan hospital between Jan. 1991 and Dec. 2000. ResultsThe accuracy of BUS or CT was higher than that of ERCP in patients with pancreatic head carcinoma (P=0.044,P=0.029, respectively). The accuracy of ERCP was higher than that of BUS or CT in patients with duodenal papillary carcinoma (P=0.005,P=0.03, respectively). The accuracy of ERCP was higher than that of BUS or CT in patients with ampullary carcinoma (P=0.157,P=0.282, respectively). The accurary of MRCP was 8/8,8/9 respectively in patients with duodenal papillary carcinoma and ampullary carcinoma. ConclusionBUS+CT is the manner of choice in the diagnosis of pancreatic head carcinoma, ERCP is suitable for nonpancreatic periampullary cancer. MRCP should be applied widely in the near future.
ObjectiveTo assess the value of palliative surgical treatment for patients with advanced periampullary carcinoma. MethodsThe clinical data of 292 cases of unresectably advanced periampullary carcinoma who had undergone palliative surgical treatment between June 1998 and June 2008 were analyzed retrospectively. ResultsThe mortality and incidence of complications after operation were 0.7% (2/292) and 24.0% (70/292), respectively. The average survival time was 10.3 months (range 4－29 months). Total bilirubin decreased to normal in 243 cases (83.2%) and decreased by 50% in 39 cases (13.4%) after operation. The totally effective rate was 96.6% (282/292). ConclusionsPalliative surgical treatment is a safe method for the patients with unresectably advanced periampullary carcinoma. Hepaticojejunostomy combined with gastrojejunostomy is recommended for these patients.
【Abstract】Objective To investigate the detection and significance of micrometastasis in lymph nodes of periampullary carcinoma. MethodsThe immunoreactivity of CK19, CK7 and CK18 in 220 lymph nodes from 60 patients who had been carried out radical resection of periampullary carcinoma were revealed by immunohistochemical method. Combining with clinical data and the followup result discussion and analysis were made. All the lymph nodes collected from January 1997 to August 2004 in this hospital were examined to be nonlymphonodus metastasis by histological HE stain. The criterion of positive CK was established and micrometastasis will be diagnosed if CKs revealed to be positive combining with the morphological changes of lymph node tissue through the observation of microscope. ResultsFortythree of 220 lymph nodes of periampullary carcinoma had been micro metastasized. The detection rates of micrometastasis were 19.55%（43/220）， 14.55%（32/220）and 11.36%（25/220） with CK19，CK7 and CK18 antibody, respectively, which meant that CK19 were better than CK18 for detection of micrometastasis. Detection rates of CK7， CK19 were higher in Ⅲ， Ⅳ stage than inⅠ， Ⅱ（P＜0.05）, whereas it had no relationship with gender, age and tumor differentiation degree. The oneyear survival rate for micrometastasis patients was lower than nonmicrometastasis patients’ (P＜0.05). Conclusion Micrometastasis of periampullary carcinoma may be the early stage of tumor metastasia. The CK antibodies are significant levels to detect micrometastasis of periampullary carcinoma and to guide the clinical treatment and prognostic judgment.
ObjectiveTo investigate the role of laparoscopic pancreaticoduodenectomy (LPD) for periampullary carcinoma. MethodsThis is a retrospective review of all periampullary carcinomas consecutively performed between January 2013 and January 2016 in Zhejiang Provincial People's Hospital. ResultsFifty-one patients underwent LPD. Conversion to open procedure was required in three cases. The operative time was (370±104) min, The estimated blood loss was (220.7±180.9) mL. Five cases had binding pancreaticogastric anastomosis, the other patients underwent duct to mucosa pancreaticojejunal anastomosis. Post operatively hospital stay was (14.6±11.2) days. The represented morbidity including pancreatic fistula (9 cases), postoperative intraperitoneal bleeding (2 cases), postoperative gastrointestinal bleeding (2 cases), delayed gastric emptying (4 cases), and bile leakage (4 cases). All patients underwent R0 resection. Postoperative pathological results: pancreatic adenocarcinoma: 28 cases, duodenal papillary adenocarcinoma: 12 cases, common bile duct adenocarcinoma: 11 cases. Conciusions LPD has been proven to be a safe procedure. Our LPD approach can improve the effectiveness of lymphadenectomy. It combined with resection of portal vein can improve the R0 resection rate of periampullary adenocarcinoma and is associated with better survival of those patients.