外科手术治疗345例壶腹周围癌的回顾性分析  

The surgical treatment of periampullary carcinoma : a review of 345 cases in a single hospital

作　　者：孙家邦[1] 李铎[1] 刘述 李非[1] 周继盛[1] 

机构地区：[1]首都医科大学宣武医院普外科,北京100053

出　　处：《中华普通外科杂志》2000年第8期454-456,共3页Chinese Journal of General Surgery

摘　　要：目的　总结近年来新的诊断和治疗技术对壶腹周围癌外科手术疗效的影响。方法　回顾性分析 195 8～ 1976年、1977～ 1987年、1988～ 1998年 3个时间段的壶腹周围癌 345例在我院的手术治疗情况。结果　 195 8～ 1976年的 12 8例中 ,胰头癌、壶腹癌、胆管下端癌及十二指肠癌所占比例分别为 6 1 7%、2 2 6 %、10 2 %及 5 5 % ,切除率分别为 2 7%、86 %、38%及 5 7% (4 / 7) ;1977～ 1987年的70例中 ,胰头癌、壶腹癌、胆管下端癌及十二指肠癌所占比例分别为 85 7%、8 6 %、1 4%及 4 3% ,胰头癌切除率为 2 7% ;1988～ 1998年的 147例中 ,胰头癌、壶腹癌、胆管下端癌及十二指肠乳头癌所占比例分别为 74 2 %、10 9%、2 7%及 12 2 % ,胰头癌切除率为 2 0 %。 1977～ 1998年壶腹癌的切除率为73 % ,胆管下端癌为 6 0 % (3/ 5 ) ,十二指肠乳头癌为 6 7%。未能切除病例多采用胆囊十二指肠吻合术。195 8～ 1976年胰十二指肠切除术的 5 5例中 1年存活率为 6 4%、3年为 38%、5年为 2 5 % ;1977～ 1987年胰十二指肠切除术的 2 3例中 ,1年存活率为 6 5 %、3年为 43 %、5年为 30 %。总并发症发生率 :195 8～1976年为 38%、1977～ 1998年为 2 5 %。 195 8～ 1976年手术死亡率为 18% ,原因依次为肝肾功能衰竭 ,胰瘘 ,?Objective [WT5”BZ] To evaluate the effect of advanced diagnostic and therapeutic means on the outcome of patients with periampullary carcinoma undergoing surgery.[WT5”HZ] Methods [WT5”BZ] Retrospective analysis of clinical data of 345 cases with periampullary carcinma in our institute during the periods of 1958～1976, 1977～1987, 1988～1998 was made. [WT5”HZ] Results [WT5”BZ] There were 128 patients in the period of 1958～1976, 79(61 7%) were of pancreatic carcinoma (PC), 29(22 6%) were ampullary carcinoma (AC),13 (10 2%) were distal bile duct cancers(DBDC), and 7(5 5%) were duodenal cancer (DC). The resection rates were 27% for PC, 86% for AC, 38% for DBDC, and 57% (4/7) for DC. During 1977～1987 there were 70 patients: 60(85 7%) were of PC, 6(8 6%) of AC, 1(1 4) of DBDC, and 3(4 3%) of DC. The resection rate for PC was 26 7%(16/60). During 1988～1998, there were 147 patients: with PC of 109(74 2%), AC of 16(10 9%), DBDC of 4(2 7%), and DC of 18(12 2%). The resection rate of PC was 20 2%. The resection rates of AC, DBDC, and DC during 1977～1998 were 72 7%(16/22), 60 0%(3/5), and 66 7%(14/21). The survival rates of patients undergoing pancreaticoduodenal resection(PDR) during 1958～1976 were 64% for 1 year, 38% for 3 year, and 25% for 5 year; during 1977～1987 that were 65% for 1 year, 43% for 3 year, and 30% for 5 year. The complication rates were 38% during 1958～1976, 25% during 1977～1998. The perioperative mortality was 18% during 1958～1976 (4 out of 55 cases died of liver and renal failure,3 of pancreatic fistula,2 of bile biliary tract infection,and one of intraabdominal bleeding) and 10% during 1977～1998 (4 of multiple organ failure 4/71,3 of bleeding,and 1 of abscess, P <0 01). 3 cases with pancreatic fistula and 1 case with bile duct fistula were cured during 1977～1998.[WT5”HZ]Conclusion [WT5”BZ] These data showed that significant improvement was achieved in the perioperative therapy for patients with periampullary cancer. [WT5”HZ]

关 键 词：外科手术 壶腹周围癌 疗效 

分 类 号：R735.0[医药卫生—肿瘤]