CAJ | 학술논문

目的探讨联合血管切除重建的胰十二指肠切除术的临床疗效.方法回顾性分析2007年1月至2011年5月第三军医大学西南医院收治的56例术前诊断为胰腺肿瘤行联合血管切除重建的胰十二指肠切除术患者的临床资料,统计患者围手术期并发症发生率、病死率及术后生存情况.结果本组患者平均手术时间为473 min(234～853 min),术中平均输血量为781 ml(0～900 ml),其中7例患者未输血;中位住院时间为25.9 d(17～100 d);43例患者进行了人工血管重建.56例患者围手术期并发症发生率为34％ (19/56),病死率为7％(4/56).术后病理诊断:胰头导管腺癌42例,壶腹部癌5例,胆管下端癌3例,十二指肠乳头癌4例,胰头神经内分泌癌1例,胰腺浆液性囊腺瘤1例.随访截至2011年8月,患者1年生存率为57％(32/56),平均生存时间为13.5个月.32例生存患者体质量均不同程度增加,无腹痛.术后3个月内5例患者有轻度腹泻,需要服用止泻药;1例患者术后1个月发现人造血管内血栓形成、中等量腹腔积液,半年后侧支循环形成,腹腔积液消失.结论对于伴有血管侵犯的胰腺肿瘤患者,应积极行联合血管切除重建的胰十二指肠切除术,能改善胰腺癌晚期患者的生命质量.
목적 탐토연합혈관절제중건적이십이지장절제술적림상료효.방법 회고성분석2007년1월지2011년5월제삼군의대학서남의원수치적56례술전진단위이선종류행연합혈관절제중건적이십이지장절제술환자적림상자료,통계환자위수술기병발증발생솔、병사솔급술후생존정황.결과 본조환자평균수술시간위473 min(234～853 min),술중평균수혈량위781 ml(0～900 ml),기중7례환자미수혈;중위주원시간위25.9 d(17～100 d);43례환자진행료인공혈관중건.56례환자위수술기병발증발생솔위34％ (19/56),병사솔위7％(4/56).술후병리진단:이두도관선암42례,호복부암5례,담관하단암3례,십이지장유두암4례,이두신경내분비암1례,이선장액성낭선류1례.수방절지2011년8월,환자1년생존솔위57％(32/56),평균생존시간위13.5개월.32례생존환자체질량균불동정도증가,무복통.술후3개월내5례환자유경도복사,수요복용지사약;1례환자술후1개월발현인조혈관내혈전형성、중등량복강적액,반년후측지순배형성,복강적액소실.결론 대우반유혈관침범적이선종류환자,응적겁행연합혈관절제중건적이십이지장절제술,능개선이선암만기환자적생명질량.
Objective To investigate the efficacy of pancreaticoduodenectomy (PD) combined with vascular resection and reconstruction.Methods The clinical data of 56 patients who received PD combined with vascular resection and reconstruction at the Southwest Hospital of Third Military Medical University from January 2007 to May 2011 were retrospectively analyzed.The incidence of perioperative complications,mortality and postoperative conditions were also analyzed.Results The mean operation time and intraoperative blood transfusion were 473 minutes (range,234-853 minutes) and 781 ml (range,0-900 ml),respectively.Seven patients did not receive blood transfusion.The median period of hospital stay was 25.9 days (range,17-100 days).A total of 43 patients underwent PD combined with vascular reconstruction.The incidence of perioperative complications and mortality rate were 34％ (19/56) and 7％ (4/56),respectively.There were 42 patients with pancreatic ductal adenocarcinoma,5 with ampullary carcinoma,3 with distal bile duct carcinoma,4 with papillary carcinoma of duodenum,1 with pancreatic neuroendocrine carcinoma and 1 with pancreatic serous cystadenoma.All patients were followed up till August 2011,and the 1-year survival rate was 57％ (32/56).The mean survival time was 13.5 months.The weight of 32 surviving patients increased and no abdominal pain occurred.Within 3 months after the operation,5 patients had slight diarrhea and were administered antidiarrheal; thrombosis in the artificial blood vessels and peritoneal effusion were found in 1 patient,while 6 months later,collateral circulation was formed and the peritoneal effusion was diminished.Conclusion PD combined with vascular resection and reconstruction can improve the quality of life for patients with pancreatic cancer and with blood vessels involvement.