临床普外科电子杂志
臨床普外科電子雜誌
림상보외과전자잡지
Journal of General Surgery for Clinicians(Electronic Version)
2015年
2期
10-18,22
,共10页
壶腹周围癌%十二指肠乳头癌%胰头癌%胆总管下端癌%根治性胰十二指肠切除术
壺腹週圍癌%十二指腸乳頭癌%胰頭癌%膽總管下耑癌%根治性胰十二指腸切除術
호복주위암%십이지장유두암%이두암%담총관하단암%근치성이십이지장절제술
Ampulla of vater carcinoma (AVC)%Duodenal papilla carcinoma%Pancreas head carcinoma%Carcinomas in the terminal of common bile duct%Radical pancreatoduodenectomy
目的 探讨根治性胰十二指肠切除术在壶腹周围癌中的临床治疗价值.方法 回顾性分析本院2005年03月至2011年03月外科手术治疗的144例AVC患者的临床资料,可分为姑息性手术组96例、手术切除组48例.结果 手术切除组术后第1年、3年及5年生存率较姑息性手术组明显提高(P<0.01),但其围手术期并发症发生率也明显升高(P<0.05),70岁以上年龄的围手术期病死率与70岁以下患者比较差异无统计学意义(P>0.05).外科治疗的不同部位肿瘤中,胰头癌患者根治切除率较胆总管下端癌及十二指肠乳头癌患者显著性降低(P<0.01),并且胰头癌患者第1年、3年、5年手术生存率也明显低于胆总管下端癌及十二指肠乳头癌患者(P<0.05, P<0.01).术前减黄治疗组与术前未减黄治疗组的围手术期并发症发生率、死亡率、及第1年、3年、5年生存率比较差异无统计学意义(P>0.05).结论 外科手术切除是治疗壶腹周围癌的重要手段,尤其根治性胰十二指肠切除术是治愈壶腹周围癌的唯一有效的治愈方法,受侵犯门静脉或肠系膜上静脉的联合切除,或联合半肝切除的扩大胰十二指肠切除术提高了治愈壶腹周围癌的机会.
目的 探討根治性胰十二指腸切除術在壺腹週圍癌中的臨床治療價值.方法 迴顧性分析本院2005年03月至2011年03月外科手術治療的144例AVC患者的臨床資料,可分為姑息性手術組96例、手術切除組48例.結果 手術切除組術後第1年、3年及5年生存率較姑息性手術組明顯提高(P<0.01),但其圍手術期併髮癥髮生率也明顯升高(P<0.05),70歲以上年齡的圍手術期病死率與70歲以下患者比較差異無統計學意義(P>0.05).外科治療的不同部位腫瘤中,胰頭癌患者根治切除率較膽總管下耑癌及十二指腸乳頭癌患者顯著性降低(P<0.01),併且胰頭癌患者第1年、3年、5年手術生存率也明顯低于膽總管下耑癌及十二指腸乳頭癌患者(P<0.05, P<0.01).術前減黃治療組與術前未減黃治療組的圍手術期併髮癥髮生率、死亡率、及第1年、3年、5年生存率比較差異無統計學意義(P>0.05).結論 外科手術切除是治療壺腹週圍癌的重要手段,尤其根治性胰十二指腸切除術是治愈壺腹週圍癌的唯一有效的治愈方法,受侵犯門靜脈或腸繫膜上靜脈的聯閤切除,或聯閤半肝切除的擴大胰十二指腸切除術提高瞭治愈壺腹週圍癌的機會.
목적 탐토근치성이십이지장절제술재호복주위암중적림상치료개치.방법 회고성분석본원2005년03월지2011년03월외과수술치료적144례AVC환자적림상자료,가분위고식성수술조96례、수술절제조48례.결과 수술절제조술후제1년、3년급5년생존솔교고식성수술조명현제고(P<0.01),단기위수술기병발증발생솔야명현승고(P<0.05),70세이상년령적위수술기병사솔여70세이하환자비교차이무통계학의의(P>0.05).외과치료적불동부위종류중,이두암환자근치절제솔교담총관하단암급십이지장유두암환자현저성강저(P<0.01),병차이두암환자제1년、3년、5년수술생존솔야명현저우담총관하단암급십이지장유두암환자(P<0.05, P<0.01).술전감황치료조여술전미감황치료조적위수술기병발증발생솔、사망솔、급제1년、3년、5년생존솔비교차이무통계학의의(P>0.05).결론 외과수술절제시치료호복주위암적중요수단,우기근치성이십이지장절제술시치유호복주위암적유일유효적치유방법,수침범문정맥혹장계막상정맥적연합절제,혹연합반간절제적확대이십이지장절제술제고료치유호복주위암적궤회.
Objective To explore the surgical clinical significance of pancreatoduodenectomy for the treatment of the patients with the ampulla of Vater carcinoma (AVC).Methods The clinical data on 144 patients with AVC from March 2005 to March 2011 in our hospital were retrospectively analyzed. All the patients with AVC were divided into 2 groups, the group of palliative surgery (n=96), and the group of radical resection (n=48) according to the surgical therapeutic methods.Results The radical resection rate of the patients with pancreas head carcinomas were lower than those of the patients with carcinomas in the terminal of common bile duct and the patients with duodenal papilla carcinomas (P<0.01). The 1-year, 3-year and 5-year survival rates in the group of radical resection were higher than those of in the group of palliative surgery (P<0.01). However,the incidence of perioperative complications in the group of radical resection was also higher than that of in the group of palliative surgery (P<0.05). There was no significant difference of the perioperative mortality in the group of radical resection between the patients with over 70 years old and the patients with lower 70 years old (P>0.05). The rates of radical resection, 1-year, 3-year and 5-year survival rates of the patients with pancreas head carcinomas were significantly lower than those of the patients with carcinomas in the terminal of common bile duct and the patients with duodenal papilla carcinomas (P<0.05,P<0.01).There was no significant difference of the perioperative mortality, complication rate, 1-year, 3-year or 5-year survival rates between the patients underwent preoperative drainage jaundice and the patients without preoperative drainage jaundice (P>0.05).Conclusion Radical resection remains one of the most important measures for the treatment of the patients with AVC, in particular, the radical pancreatoduodenectomy (PD) is the only effective way for the patients with AVC. The radical pancreatoduodenectomy could improve the cure rate of the patients with AVC. The radical pancreatoduodenectomy combined with resection of portal vein or superior mesenteric vein or hemihepatectomy at the same time also could significantly increase the cure rate of the patients with AVC and improve the life quality of the patients with AVC.
