This paper present 78 patients with periampullary carcinoma, whose medical records were available and who received laparotomy at the Department of Surgery of S.N.U..H. from May 1974, to may 1980. The results were as follows: 1) 51. 3% of ail periampuliary carcinoma were of pancreas head, 35. 9,. were of distal cammon bile duct, 7. 7,. were of ampulla of Vater, and 5. 1were of duodenum. 2) Male to female ratio was 1. 9: 1 and average age was 57. 3 years. 3) Chief complaints were jaundice (46%), abdominal pain (30.8%), fever and chill(3.8), indigestion,(3. 8%), back pain (l.3%), and hematemesis (l.3%). Average duration of chief complaints was 2. 9 Months. 4) Freguent subjective symptoms were jaundice (80.8%), RUQ pain (43.6%), epigastric pain (42.3%), Pururitus (30.8%), fever % chill (28.2%), anorexia (28. 2%), weakness (25.6%), inriigestion (23.1%), nausea and vomiting (9. 0%), GI bleeding (5.1%) and back pain (3.8%). 5) Frequent physical findings were hepatomegaly (66.7%), wt loss (48.7%), palpation of gailbadder (19. 5%), RUQ mass (28. 2%) and ascites (10.3%). 6) Importan#t laboratory findings were reversed A/G ratio (66. 2%), increased alkaline phosphatase (85. 7%), increased bilirubin (74. 4%), increased SGOT(74.4%), increased SGPT (57.7%) and prolonged pnthrombin time (20.8%). On stool examination occult blood was positive in 48.1%. 7) Most effective method of investigation was P.T.C. The rate of abnormal find- ings of P.T.C. was 94.6%, oral GB & IVC were 90% ultrasonography was 87. 5%, ERCP was 85.7%, Liver scan was 78.4%, HTD was 70.0%, and UGI was 58.1%, 8) Diagnostic accuracy of periampullary carcinoma was 70. 5%. 9) Whipple procedures were performed on 21 patients, palliative procedures on 44 patients, and biopsy only on 13 patients. Resectability of perjampullary carcinoma was26.9%. 10) In 21 patients who received whipple procedures, absence of metastasis to regional lymphnodes was 38.1%. 11) Postoperative bilirubin level was decreased in 83.3% of whipple procedures, and 47.5% of palliative procedures. 12) Postoperative compoications occured of 26.9% of perlampllary carcinoma, and operative mortalicy was 19.2%. 13) Average survival rate of periampullary carcinoma was 10.7 months. the 1 year survival rate was 37.5% overall, the 2 year survival rate was 12.5%, the 3 year survival rate was 6.5%, and the 4 year survival rate was 3.2%.
|