壺腹腺癌之診斷與治療現況

10.6666/ClinMed.202407_94(1).0078

李佳儒；李沛璋

ampulla of Vater adenocarcinoma ； 胰十二指腸切除術（whipple operation） ； 化療（chemotherapy）

臨床醫學月刊

94卷1期（2024 / 07 / 26）

444 - 449

繁體中文

壺腹腺癌為發生於十二指腸壺腹部位的腸胃道惡性腺癌，其診斷治療因其罕見性而具挑戰性。雖然在胃腸道惡性腫瘤中所占比例較低，但發生率卻逐年升高。臨床表現多為阻塞性黃疸，可能伴有腹瀉、體重減輕等症狀。診斷壺腹腺癌需要綜合理學檢查、血液檢測、影像學檢查及病理組織分析。治療方面，早期壺腹腺癌的首選治療為手術切除，胰十二指腸切除術是十二指腸壺腹周遭腫瘤切除的首選術式。由於手術複雜度高，腫瘤切除後可能伴有術後併發症，如延遲胃排空、膽汁或胰液洩漏等，影響術後營養狀態及預後。術後是否需要追加化學治療，則取決於病理檢體分析，原則上第三期以上患者需要術後化療。第二期患者化療與否取決於病理檢體是否具有高風險復發因子而定。隨著精準醫療的發展，基於細胞分型和基因突變報告的藥物治療能夠改善病患存活預後。化療藥物的選擇應根據腫瘤為胰腺膽道型或腸道型細胞選擇相應的治療配方。對於疾病惡化或進展的患者，可以考慮基於基因突變選擇標靶治療或免疫治療。儘管癌症治療取得了進步，壺腹腺癌的治療仍面臨挑戰，因缺乏基於大規模隨機對照試驗的標準治療方案。未來需要進行更多研究，以建立專門針對壺腹腺癌的治療指南，從而改善患者的預後和生活品質。

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