|Title:||The Endoscopic Study of Carcinoma of the Ampulla of Vater
Lee, Hsuan-Shu et al.
|Keywords:||乏特氏壺腹癌;內視鏡;carcinoma of the Ampulla Vater;endoscopy||Issue Date:||1992||Journal Issue:||n.4||Start page/Pages:||279-286||Source:||中華民國消化系醫學會雜誌,v.9||Abstract:||
為了探討影響乏特氏壺腹癌之診斷、治療，分期及預後之因素，吾人經病歷整理自民 國六十六年到民國七十八年國立台灣大學附設醫院住院病例，經組織學證實為乏特氏 壺腹癌有40例，其中34例有完整之內視鏡肉眼觀察或問刀發現，參照並加以修飾日本 學者永川之分類，將其形態分成四種類型(1)外形近乎正常或輕度腫大型；(2)息肉樣 型；(3)息肉樣併潰瘍型；(4)潰瘍型。並依Neoptolemons等病理分期，分成四個病期 ，以探討乏特氏壺腹癌的內視鏡形態，對診斷、分期預後之影響。 34例病人，平均 年齡54.2歲(27-83)，男與女之比例為1.4: 1，臨床上剛問始有症狀者為52.9%，畏寒 發燒者佔50%，腹痛者佔52. 9%，上腹脹者只有8.8%。在理學檢查方面，有黃疸現象 者為79.4%，有貧血現象者佔23.5%腹部壓痛者有29.4%，膽囊可摸到佔38.2%。在實驗 室檢查發現，膽紅素升高者有93%，鹼性磷酸酶升高者佔94%,AST及ALT升高者 分別為76%與64.5%，其臨床症狀及生化檢查，在統計學上無顯著意義。但第一類型的 病人，無論在外形診斷及組織生檢上，都較其它三型不易診斷，相對的這些第一類型 的病例，分期較早，切除率高，且預後較好，在統計學上有明顯的意義。 To evaluate the correlation of the endoscopic appearance to the clinical outcome of carcinoma of ampulla Vater, 34 patients with histologically proven ampullary carcinoma or complete endoscopic examination were studied . The endoscopic appearances of the ampulla of Vater were classified into 4 types according to Nagakawa's report and modified: (Ⅰ)Normal or slightly enlarged papilla; (Ⅱ) polypoid type; (Ⅲ) polypoid papilla with ulceration; (Ⅳ) ulcerative type. The pathological staging was made according to Neoptolemen's staging criteria. Patients included 20 men and 14 women. The mean age was 54.2 years (range 27-83 years). Based on the endoscopic findings, 8 patients were classified as type I, 10 patients as type Ⅱ, 8 patients as type Ⅲ, and 8 patients as type Ⅳ. The most common laboratory findings were elevated serum alkaline phosphatase (94%), bilirubin ( 93%), alanine aminotransferase (64%), and aspartate aminotransferase (76%). No significant difference in clinical manifestation was noted among the 4 types of ampullary carcinoma. However, type Ⅰ ampullary carcinoma showed a lower endoscopic diagnosis rate, an earlier pathological staging, and a more favorable prognosis than other types; and contrarily, type Ⅳ ampullary carcinoma showed a more advanced pathological stage and a poorer prognosis. It is concluded that endoscopic appearance is closely related to pathological staging and clinical outcome , and that early diagnosis of type lampullary carcinoma is clinically important and needs careful evaluation.
|Appears in Collections:||醫學系|
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