摘要
目的 用回顾性方法研究近 30年胰腺癌行根治性胰十二指肠切除术的相关因素 ,探讨手术及肿瘤的性状与生存的关系。方法 华山医院 1970～ 1999年收治的 377例行手术治疗的胰腺癌病人 ,其中 75例行Whipple手术或区域性胰十二指肠切除术 (包括 10例介入治疗后再手术切除病例 )。结果 手术切除率从 70年代的 9%提高到 90年代的 2 8 2 %。区域性胰十二指肠切除术 ,包括淋巴结廓清 ,对累及门静脉和肠系膜上静脉的病例行静脉切除及搭桥术 ,也增加了手术的切除率及生存率。手术后 1,3,5年的生存率在 70年代分别为 5 0 % ,2 5 %和 0 % ,80年代为 5 7 1% ,2 8 5 %和 9% ,90年代为 6 1 6 % ,2 7%和 11 1%。结论 胰头癌病人的长期生存与肿瘤的大小 ,淋巴结转移和神经丛的浸润有关 ,因而提出在掌握标准的Whipple(DP)技术后可以做广泛的淋巴结和软组织清除 ,清扫范围达腹主动脉旁 (EP) ,必要时可采用区域性胰腺切除 (RP) 。
Objective To evaluate the relationship between the type of operation, character of tumor and patients′ survival time by retrospective study of radical pancreatoduodenectomy for carcinoma of pancreatic head performed in recent 30 years. Methods Of 377 cases of carcinoma of pancreas operated during 1970-1999, 75 were subjected to Whipple procedure or pancreatectomy with regional dissection (including 10 cases with intervention therapy). Pancreatectomy with regional dissection means a thorough regional lymph node dissection and resection of a segment of involved superior mesenteric portal vein confluence. The latter is beneficial for carcinoma of the pancreas head. Results The resectability was increased from 9% in 1970s to 28.2% in 1991-1999. Survival rate of 1,3,5 years was 50%, 25%, 0% in 1970s; 57.1%, 28.5%, 9% in 1980s; and 61.6%, 27%, 11.1% in 1990s, respectively. Conclusions Despite being retrospective in nature, the present study suggests that in patients suffering from pancreatic carcinoma without visceral metastasis, resection should always be attempted when there is absence of high operative risk factor and the operation is technically feasible.
出处
《中华肝胆外科杂志》
CAS
CSCD
2000年第2期92-94,共3页
Chinese Journal of Hepatobiliary Surgery
