十二指腸乳頭部癌の外科治療―幽門輪温存膵頭十二指腸切除術を中心に

Surgical Treatment and Prognosis for Cancer of the Ampulla of Vater: Pylorus-preserving Pancreatoduodenectomy

要旨　十二指腸乳頭部癌の外科治療と予後についてまとめた．当科で1987～1996年に乳頭部癌に対して施行した幽門輪温存膵頭十二指腸切除術は29例であった．4例の絶対的非治癒切除を除く25例の5年生存率は52.1％であった．予後を規定する因子として膵浸潤とリンパ節転移が特に重要であった．癌浸潤がOddi筋内にとどまる早期乳頭部癌の5年生存率は100％であった．根治性とQOLを考慮した治療として幽門輪温存膵頭十二指腸切除術が乳頭部癌に対しての合理的な手術であろう．また画像診断の進歩とともに，内視鏡的乳頭切除術を含めた縮小手術も視野に入ってきた．

　Twenty-nine patients with cancer of the ampulla of Vater, resected from 1987 to 1996 by pylorus-preserving pancreatoduodenectomy (PpPD) at the first department of surgery in Fukuoka University Hospital, were evaluated. The overall 5-year-survival rate was 52.1% in 25 patients who had curative resection. Pancreatic invasion and lymph nodes metastasis were important prognostic factors. Early cancer with no invasion into the pancreas and duodenum, had 100% of 5-year-survival rate. PpPD may be a rational method of treatment for cancer of the ampulla of Vater without decreasing radicality in lymph nodes dissection, because it prevent complication such as indigestion and malabsorption that are carsed by extended operation.