Clinical Analysis Of Ampullary Carcinoma And Meta Analysis Of Surgical Treatment For Tis-T2 Ampullary Carcinoma

[Objective]1、To summarize and analyze the clinical features,imaging findings and pathological features of ampullary carcinoma;2、To investigate the prognostic factors of ampullary carcinoma after surgical treatment;3、Meta analysis was used to evaluate the curative effect of pancreatoduodenectomy and local excision for ampullary carcinoma of Tis-T2 stage.From the perspective of evidence-based medicine,the local treatment for ampullary carcinoma was provided.[Methods]1.Methods the clinical data of patients with ampullary carcinoma who were pathologically treated from 2005 to 2016 in Shangdong Province-owned Hospital were analyzed retrospectively.Kaplan-Meier method was used to analyze the survival data,and Log-rank test was used to compare the data.2.PubMed,Embas and Cochrane Library were systematically searched by computer and manually for published studies about the comparison of LR and PD of the ampullary cancer(up to May 2016).Pooled odds ratio(OR)and 95%confidence interval(CI)were estimated using fixed-effect analyses,or random effects analyses if there was statistically significant heterogeneity(P<0.05).[Results]1.The 1,3 and 5 year survival rates of 96 ampullary cancer patients were 82.9%,57.2%and 29.6%respectively.Preoperative B ultrasound,CT and MRI are the most common examination methods,and CT and MRI have higher detection rate than B ultrasound.The accurate rate of endoscopic biopsy was 73.3%.The tumor diameter and tumor invasion depth had significant relationship(p<0.05),tumor T stage single factor analysis(p=0.042),tumor size(P=0.035),primary tumor and lymph node metastasis(p=0.000)were prognostic factors.Lymph node metastasis is an independent risk factor for survival in patients with ampullary carcinoma.2.Meta analysis was used to compare the curative effect of PD and LR in two patients to ampullary carcinoma of the Tis-T2 stage.A total of 11 studies were conducted,and LR was superior to PD in all surgical complications.The tumor recurrence rate and the 5 year survival rate were not statistically different between the two operation methods.[Conclusions]1.The diameter of tumor was significantly related to the depth of tumor invasion(p<0.05),and the depth of invasion could be estimated by tumor diameter,preoperative and intraoperative diagnosis.2.The depth of tumor invasion,the size of tumor and lymph node metastasis of primary tumor are the prognostic factors.Lymph node metastasis is an independent risk factor for survival in patients with ampullary carcinoma.3.Meta analysis showed that for the treatment of ampullary carcinoma of stage Tis-T2,the incidence of postoperative complications was significantly lower than that of PD.The recurrence rate and the 5 year survival rate of the surgical methods were not statistically different between the two groups.4.For patients with stage Tis-T2,LR is a feasible surgical procedure relative to PD with less postoperative complications and without affecting the prognosis.5.Meet the following two indications of ampullary cancer patients in the consent of the patient,can be considered for the treatment of local resection for ampullary carcinoma:clinical stage Tis-T2,<2cm and tumor diameter,pathological differentiation;obvious lymph node metastasis without intraoperative preoperative checking.