胰头癌的外科手术综合治疗143例临床分析  

Clinical analysis of pancreatic head carcinoma with surgical comprehensive treatment in 143 cases

作　　者：刁同进[1] 赵晓东[2] 陈新 庄兴俊[4] 袁伟升[1] 

机构地区：[1]中国人民解放军济南军区第401医院肝胆外科,山东青岛266011 [2]中国人民解放军济南军区第401医院普外科,山东青岛266071 [3]青岛市城阳区人民医院急诊科,山东青岛266011 [4]中国人民解放军济南军区第401医院肿瘤内科,山东青岛266011

出　　处：《肝胆胰外科杂志》2013年第5期376-380,384,共6页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨胰十二指肠切除术治疗胰头癌的外科临床价值。方法回顾性分析我院2005年3月至2009年3月外科治疗的143例胰头癌患者的临床资料,分为非手术治疗组(27例)、姑息性手术组(88例)、手术切除组(28例)。结果本组外科治疗胰头癌143例,随访率97.4%(140/143),中位生存时间11.3个月,1、3及5年术后生存率分别49.1%、10.3%、4.3%。其中,外科手术治疗的胰头癌患者的根治性切除率为24.1%(28/116),手术切除组1、3及5年术后生存率(85.7%、42.9%、17.9%,中位生存时间25.5个月)较非手术治疗组(0、0、0,中位生存时间6.6个月)或姑息性手术组(37.5%、0、0,中位生存时间8.3个月)明显提高(P<0.01),但其围手术期并发症发生率也明显升高(P<0.05)。三组围手术期病死率差异无统计学意义(P>0.05)。术前减黄组与术前未减黄组在围手术期并发症发生率、死亡率及1、3、5年生存率方面比较,其差异无统计学意义(P>0.05)。结论外科手术切除是治疗胰头癌的重要手段,尤其根治性胰十二指肠切除术是治愈胰头癌的唯一有效的方法,联合门静脉或肠系膜上静脉切除术、半肝切除的胰十二指肠扩大切除术提高了胰头癌的根治性切除率、临床治愈的机会以及改善了患者的生存质量。Objective To explore the clinical significance of pancreatoduodenectomy in the treatment ofpancreatic head carcinoma. Methods Retrospective analysis of 143 patients in our hospital undergoing pancreatic head carcinoma from Mar. 2005 to Mar. 2009 was performed. Patients were divided into non-surgery group （27 cases）, palliative surgical group （88 cases） and surgical resection group （28 cases） according to the resection status of pancreatic head carcinoma. Results A total of 143 patients with 97.4% follow-up rate and median survival of 11.3 months was analyzed retrospectively. Patients survival rates at 1, 3, and 5 years were 49.1%, 10.3% and 4.3%, respectively. Radical resection rates of patients with pancreatic head carcinoma were 24.1% （28/116）. Comparing with non-surgery group （0, 0, 0, middle survival time was 6.6 months） or the palliative surgical group （37.5%, 0, 0, middle survival time was 8.3 months）, I, 3 and 5 years survival rate after operation for surgical resection group （85.7%, 42.9%, 17.9%, middle survival time was 25.5 months） improved remarkably （P 〈0.01）. However, the incidence of perioperative morbidity in surgal resection group significantly increased （P〈0.05） and no difference was found for mortality among three groups （P〉0.05）. There was no significant difference between preoperative biliary drainage and non-preoperative biliary drainage （P〉0.05） in perioperative morbidity, mortality and survival rates at 1, 3, and 5 years. Conclusion Surgical resection has been an important way to cure pancreatic head carcinoma, especially radical pancreaticoduodenectomy is the only effect way to treat pancreatic head carcinoma. Pancreaticoduodenectomy with portal vein, superior mesenteric vein and hemihepatectomy can im- prove the radical resection rate of pancreatic head carcinoma, it＇s also helpful to provide chance with curing and improving life quality of patients.

关 键 词：胰头癌 根治性胰十二指肠切除术 

分 类 号：R735.9[医药卫生—肿瘤]