CAJ | 학술논문

目的通过比较保留十二指肠升部的改良胰十二指肠切除术与胰十二指肠切除术的治疗效果,探讨改良手术在壶腹部癌治疗中的价值.方法回顺性分析1990年至2006年山东大学齐鲁医院收治的133例壶腹部癌患者的临床资料.其中88例行胰十二指肠切除术(经典手术组),45例行保留十二指肠升部的改良胰十二指肠切除术(改良手术组);通过Fisher确切概率法、t检验、χ2检验、Log-rank检验比较两组患者术前情况及术后近期和远期疗效,探讨两种手术方式在治疗效果上的差异.结果经典手术组和改良手术组的手术时间分别为(366±111)min和(325±32)min,两组比较差异有统计学意义(t=2.34,P<0.05);术中输血比例分别为76%(67/88)和42%(19/45),两组比较差异有统计学意义(χ2=14.99,P<0.05).两组患者术后主要并发症发生率比较差异无统计学意义(P>0.05).经典手术组和改良手术组胃肠道功能的恢复时间分别为(7.4±1.4)d和(4.3±1.4)d,两组比较差异有统计学意义(t=2.08,P<0.05);住院时间分别为(24±9)d和(31±14)d,两组比较差异有统计学意义(t=1.98,P<0.05).经典手术组和改良手术组中位生存时间分别为(19.0±1.5)个月和(16.9±1.7)个月,两组比较差异无统计学意义(χ2=0.46,P>0.05).结论保留十二指肠升部的改良胰十二指肠切除术可用于壶腹部癌患者的治疗.
목적 통과비교보류십이지장승부적개량이십이지장절제술여이십이지장절제술적치료효과,탐토개량수술재호복부암치료중적개치.방법 회순성분석1990년지2006년산동대학제로의원수치적133례호복부암환자적림상자료.기중88례행이십이지장절제술(경전수술조),45례행보류십이지장승부적개량이십이지장절제술(개량수술조);통과Fisher학절개솔법、t검험、χ2검험、Log-rank검험비교량조환자술전정황급술후근기화원기료효,탐토량충수술방식재치료효과상적차이.결과경전수술조화개량수술조적수술시간분별위(366±111)min화(325±32)min,량조비교차이유통계학의의(t=2.34,P<0.05);술중수혈비례분별위76%(67/88)화42%(19/45),량조비교차이유통계학의의(χ2=14.99,P<0.05).량조환자술후주요병발증발생솔비교차이무통계학의의(P>0.05).경전수술조화개량수술조위장도공능적회복시간분별위(7.4±1.4)d화(4.3±1.4)d,량조비교차이유통계학의의(t=2.08,P<0.05);주원시간분별위(24±9)d화(31±14)d,량조비교차이유통계학의의(t=1.98,P<0.05).경전수술조화개량수술조중위생존시간분별위(19.0±1.5)개월화(16.9±1.7)개월,량조비교차이무통계학의의(χ2=0.46,P>0.05).결론 보류십이지장승부적개량이십이지장절제술가용우호복부암환자적치료.
Objective To investigate the value of modified pancreatoduodenectomy in the treatment of ampullary carcinoma by comparing the efficacy of pancreatoduodenectomy with preservation of ascending portion of duodenum and that of Whipple procedure. Methods The clinical data of 133 patients with ampullary carcinoma who had been admitted to the Qilu Hospital from 1990 to 2006 were retrospectively analyzed. Of the 133 patients, 88 received Whipple procedure (group A) and 45 received pancreatoduedenectomy with preservation of ascending portion of duodenum (group B). The preoperative condition of the patients and short- and long-term efficacy of the 2 procedures were compared by Fisher exact probability, t test, chi-square test, Kaplan-Meier survival curve and Log-rank test, and the differences between the efficacy of the 2 procedures were compared. Results The operation time, time of gastrointestinal function recovery, hospital stay and ratio of patients with blood transfusion were (366±111) minutes, (7.4±1.4) days, (24±9) days and 76% (67/88) in group A, and (325±32)minutes, (4.3±1.4)days, (31±14)days, 42% (19/45) in group B, with significant difference between the 2 groups (t = 2.34, 2.08, 1.98 ; χ2 = 14.99, P < 0.05). The medium survival time of patients in groups A and B were (19.0±1.5)months and (16.9±1.7) months, with no significant difference between the 2 groups (χ2 = 0.46, P > 0.05). There was no significant difference in the occurrence of postoperative complications between the 2 groups (P > 0.05). Conclusions Pancreateduodenectomy with preservation of ascending portion of duodenum can be applied for patients with ampullary carcinoma.