胃癌侵犯或累及胰十二指肠区域的手术治疗选择  

Choice of surgical therapy for the pancreaticoduodenal region invaded by or involved in stomach carcinoma.

作　　者：何裕隆[1] 陈创奇[1] 郑章清[1] 彭俊生[1] 刘统成[1] 黄美近[1] 蔡世荣[1] 詹文华[1] 

机构地区：[1]中山医科大学附属第一医院胃肠胰外科,广州510080

出　　处：《中国实用外科杂志》2000年第11期658-660,共3页Chinese Journal of Practical Surgery

摘　　要：目的　探讨胃癌侵犯或累及胰十二指肠区域的手术治疗选择。方法　回顾性研究了自 1994年 6月至 1999年 12月间收治的 42例胃癌病人。结果　原发性胃癌 41例 ,胃癌术后复发 1例。术式分别为单纯胃癌根治术 2 1例 (单纯组 ) ,胃癌根治及胰十二指肠切除术 (PD组 ) 12例和姑息手术 9例 (即姑息组 ,包括姑息性切除术 2例 ,姑息性胃空肠吻合术 3例 ,剖腹探查及腹腔内肿物活检术 3例 ,胃造口术 1例 )。单纯根治术后并发症 2例 ,发生率为 9 5 % ,其术后1、3年生存率分别为 6 0 7%和 5 2 0 % ;PD组术后并发症 4例 ,发生率为 33 3 % ,其术后 1、3、5年生存率分别为 6 0 9%、36 5 %和 36 5 %。PD组、单纯组分别与姑息组相比生存率明显提高 (P <0 0 1)。结论　对侵犯或累及胰十二指肠区域的胃癌采用何种手术治疗 ,应具体问题具体分析 ,有根治切除或联合PD手术指征时应积极手术 ,可提高术后生存率。Objective To investigate the choice of surgical therapy for the pancreaticoduodenal region invaded by or involved in stomach carcinoma.Methods 42 patients with stomach carcinoma invaded by or involved in pancreaticoduodenal region from June 1994 to December 1999 were analyzed retrospectively.Results The patients were with primary gastric cancer(n=41) and recurrence after gastric cancer radical surgery (n=1).The operative methods of gastric cancer included simple radical resection(SRR group,n=21),radical pancreaticoduodenectomy(PD group,n=12),and palliative operation(PO group,n=9),including gastrostomy (n=1),palliative resection of tumor (n=2),gastrojejunostomy (n=3),and laparotomy and tumor's biopsy (n=3).In SRR group,one-,and three-year survival rate was 60 7% and 52% respectively,and postoperative complication rate was 9 5%(2/21).But the postoperative complication rate of PD group was 33 3%(4/12),and one-,three- and five-year survival rate was 60 9%,36 5% and 36 5% respectively.The survival rate of PD group and SRR group was markedly better than that of PO group respectively (P<0 01).Conclusion Which operative method to be chose on the patients with gastric cancer invading or involving in pancreaticoduodenal region?We should make a concrete analysis of concrete problems.If there are operative indications of radical resection or combined PD resection,radical surgical therapy should be actively completed,thus the postoperative survival rate can be improved.

关 键 词：胃肿瘤 胰十二指肠切除术 手术治疗 

分 类 号：R735.2[医药卫生—肿瘤] R657.5[医药卫生—临床医学]