目的 比较保留幽门的胰十二指肠切除术(PPPD)与标准胰十二指肠切除术(SPD)治疗壶腹周围癌的近期效果.方法 回顾性分析2010年10月至2012年10月复旦大学附属中山医院收治的85例壶腹周围癌患者的临床资料.44例患者行PPPD设为PPPD组,41例患者行SPD设为SPD组.观察2组患者术中情况,分析胰瘘(B级及以上)、胆瘘、出血、腹腔感染、胃排空障碍和患者预后情况.采用电话和门诊方式随访,术后第1年每3个月随访1次,术后第2～3年每6个月随访1次,随访时间截至2014年10月.计数资料比较采用x2检验,计量资料用M(Qn)表示,比较采用Mann-Whitney U检验.Kaplan-Meier法绘制生存曲线,生存分析采用Log-rank检验.结果 PPPD组患者的手术时间为195 min(180 min,240 min),SPD组患者为210 min(180 min,300 min),两组比较,差异有统计学意义(Z=-2.090,P＜0.05).PPPD组患者的术中出血量、术中输血量及术后住院时间分别为200 mL(113 mL,288 mL)、0 mL(0 mL,0 mL)和17 d(12 d,24 d),SPD组患者上述指标分别为200 mL(150 mL,325 mL)、0 mL(0 mL,400 mL)和16 d(12 d,30 d),两组比较,差异均无统计学意义(Z=-1.185,-1.780,-0.533,P＞0.05).两组均无围术期死亡患者,总体并发症发生率42.4％(36/85),以胰瘘、腹腔感染及胃排空障碍多见.PPPD组患者术后胃排空障碍的发生率为20.5％ (9/44),高于SPD组的4.9％ (2/41),两组比较,差异有统计学意义(x2=4.571,P＜0.05);PPPD组患者术后胰瘘、胆瘘、腹腔感染及术后出血发生率和2个及以上并发症发生率分别为20.5％(9/44)、2.3％ (1/44)、15.9％ (7/44)、4.5％ (2/44)、25.0％ (11/44),SPD组患者上述指标分别为14.6％ (6/41)、4.9％ (2/41)、19.5％(8/41)、7.3％(3/41)、14.6％ (6/41),两组比较,差异均无统计学意义(x2=0.495,0.423,0.295,0.190,1.425,P＞0.05).85例患者均获随访,随访时间为6～47个月,中位随访时间为31个月.85例患者的术后1、3年总体生存率分别为95.3％、75.5％;PPPD组患者的术后1、3年总体生存率分别为97.7％和78.9％,SPD组患者术后1、3年生存率为92.7％和71.7％,两组患者术后3年生存率比较,差异无统计学意义(x2=0.690,P＞0.05).无淋巴结转移患者与有淋巴结转移患者的术后3年生存率分别为80.5％、54.9％,两者比较,差异有统计学意义(x2=4.290,P＜0.05).结论 治疗壶腹周围癌,PPPD与SPD均能获得良好的近期疗效;PPPD手术时间短于SPD,但术后胃排空障碍的发生率高于SPD;淋巴结转移是影响壶腹周围癌术后短期生存率的重要因素,对有淋巴结转移的壶腹周围癌患者不建议行PPPD.
目的 比較保留幽門的胰十二指腸切除術(PPPD)與標準胰十二指腸切除術(SPD)治療壺腹週圍癌的近期效果.方法 迴顧性分析2010年10月至2012年10月複旦大學附屬中山醫院收治的85例壺腹週圍癌患者的臨床資料.44例患者行PPPD設為PPPD組,41例患者行SPD設為SPD組.觀察2組患者術中情況,分析胰瘺(B級及以上)、膽瘺、齣血、腹腔感染、胃排空障礙和患者預後情況.採用電話和門診方式隨訪,術後第1年每3箇月隨訪1次,術後第2～3年每6箇月隨訪1次,隨訪時間截至2014年10月.計數資料比較採用x2檢驗,計量資料用M(Qn)錶示,比較採用Mann-Whitney U檢驗.Kaplan-Meier法繪製生存麯線,生存分析採用Log-rank檢驗.結果 PPPD組患者的手術時間為195 min(180 min,240 min),SPD組患者為210 min(180 min,300 min),兩組比較,差異有統計學意義(Z=-2.090,P＜0.05).PPPD組患者的術中齣血量、術中輸血量及術後住院時間分彆為200 mL(113 mL,288 mL)、0 mL(0 mL,0 mL)和17 d(12 d,24 d),SPD組患者上述指標分彆為200 mL(150 mL,325 mL)、0 mL(0 mL,400 mL)和16 d(12 d,30 d),兩組比較,差異均無統計學意義(Z=-1.185,-1.780,-0.533,P＞0.05).兩組均無圍術期死亡患者,總體併髮癥髮生率42.4％(36/85),以胰瘺、腹腔感染及胃排空障礙多見.PPPD組患者術後胃排空障礙的髮生率為20.5％ (9/44),高于SPD組的4.9％ (2/41),兩組比較,差異有統計學意義(x2=4.571,P＜0.05);PPPD組患者術後胰瘺、膽瘺、腹腔感染及術後齣血髮生率和2箇及以上併髮癥髮生率分彆為20.5％(9/44)、2.3％ (1/44)、15.9％ (7/44)、4.5％ (2/44)、25.0％ (11/44),SPD組患者上述指標分彆為14.6％ (6/41)、4.9％ (2/41)、19.5％(8/41)、7.3％(3/41)、14.6％ (6/41),兩組比較,差異均無統計學意義(x2=0.495,0.423,0.295,0.190,1.425,P＞0.05).85例患者均穫隨訪,隨訪時間為6～47箇月,中位隨訪時間為31箇月.85例患者的術後1、3年總體生存率分彆為95.3％、75.5％;PPPD組患者的術後1、3年總體生存率分彆為97.7％和78.9％,SPD組患者術後1、3年生存率為92.7％和71.7％,兩組患者術後3年生存率比較,差異無統計學意義(x2=0.690,P＞0.05).無淋巴結轉移患者與有淋巴結轉移患者的術後3年生存率分彆為80.5％、54.9％,兩者比較,差異有統計學意義(x2=4.290,P＜0.05).結論 治療壺腹週圍癌,PPPD與SPD均能穫得良好的近期療效;PPPD手術時間短于SPD,但術後胃排空障礙的髮生率高于SPD;淋巴結轉移是影響壺腹週圍癌術後短期生存率的重要因素,對有淋巴結轉移的壺腹週圍癌患者不建議行PPPD.
목적 비교보류유문적이십이지장절제술(PPPD)여표준이십이지장절제술(SPD)치료호복주위암적근기효과.방법 회고성분석2010년10월지2012년10월복단대학부속중산의원수치적85례호복주위암환자적림상자료.44례환자행PPPD설위PPPD조,41례환자행SPD설위SPD조.관찰2조환자술중정황,분석이루(B급급이상)、담루、출혈、복강감염、위배공장애화환자예후정황.채용전화화문진방식수방,술후제1년매3개월수방1차,술후제2～3년매6개월수방1차,수방시간절지2014년10월.계수자료비교채용x2검험,계량자료용M(Qn)표시,비교채용Mann-Whitney U검험.Kaplan-Meier법회제생존곡선,생존분석채용Log-rank검험.결과 PPPD조환자적수술시간위195 min(180 min,240 min),SPD조환자위210 min(180 min,300 min),량조비교,차이유통계학의의(Z=-2.090,P＜0.05).PPPD조환자적술중출혈량、술중수혈량급술후주원시간분별위200 mL(113 mL,288 mL)、0 mL(0 mL,0 mL)화17 d(12 d,24 d),SPD조환자상술지표분별위200 mL(150 mL,325 mL)、0 mL(0 mL,400 mL)화16 d(12 d,30 d),량조비교,차이균무통계학의의(Z=-1.185,-1.780,-0.533,P＞0.05).량조균무위술기사망환자,총체병발증발생솔42.4％(36/85),이이루、복강감염급위배공장애다견.PPPD조환자술후위배공장애적발생솔위20.5％ (9/44),고우SPD조적4.9％ (2/41),량조비교,차이유통계학의의(x2=4.571,P＜0.05);PPPD조환자술후이루、담루、복강감염급술후출혈발생솔화2개급이상병발증발생솔분별위20.5％(9/44)、2.3％ (1/44)、15.9％ (7/44)、4.5％ (2/44)、25.0％ (11/44),SPD조환자상술지표분별위14.6％ (6/41)、4.9％ (2/41)、19.5％(8/41)、7.3％(3/41)、14.6％ (6/41),량조비교,차이균무통계학의의(x2=0.495,0.423,0.295,0.190,1.425,P＞0.05).85례환자균획수방,수방시간위6～47개월,중위수방시간위31개월.85례환자적술후1、3년총체생존솔분별위95.3％、75.5％;PPPD조환자적술후1、3년총체생존솔분별위97.7％화78.9％,SPD조환자술후1、3년생존솔위92.7％화71.7％,량조환자술후3년생존솔비교,차이무통계학의의(x2=0.690,P＞0.05).무림파결전이환자여유림파결전이환자적술후3년생존솔분별위80.5％、54.9％,량자비교,차이유통계학의의(x2=4.290,P＜0.05).결론 치료호복주위암,PPPD여SPD균능획득량호적근기료효;PPPD수술시간단우SPD,단술후위배공장애적발생솔고우SPD;림파결전이시영향호복주위암술후단기생존솔적중요인소,대유림파결전이적호복주위암환자불건의행PPPD.
Objective To compare the short-term efficacy of pylorus-preserving pancreaticoduodenectomy (PPPD) and standard pancreaticoduodenectomy (SPD) for the treatment of periampullary carcinoma.Methods The clinical data of 85 patients with periampullary carcinoma who were admitted to the Zhongshan Hospital of Fudan University from October 2010 to October 2012 were retrospectively analyzed.Forty-four patients who underwent PPPD were divided into the PPPD group and 41 patients who underwent SPD were divided into the SPD group.The pancreatic fistula(Grade B and above), biliary fistula, blood loss, intra-abdominal infection, delayed gastric emptying (DGE) and prognosis were analyzed.Patients were followed up by telephone interview and outpatient examination once every 3 months within postoperative 1 year and once every 6 months within postoperative 2-3 years till October 2014.Count data were analyzed using the chi-square test, measurement data with normal distribution were presented as M(Qn) and comparison was analyzed using the Mann-Whitney U test.The survival curve was drawn by the Kaplan-Meier method, and survival rate was analyzed using the Log rank test.Results The operation time was 195 minutes (180 minutes, 240 minutes) in the PPPD group and 210 minutes (180 minutes,300 minutes) in the SPD group, with a significant difference (Z =-2.090, P ＜ 0.05).The volume of intraoperative blood loss, intraoperative blood transfusion and duration of postoperative hospital stay were 200 mL(113 mL,288 mL), 0 mL(0 mL, 0 mL) and 17 days(12 days, 24 days) in the PPPD group, and 200 mL(150 mL, 325 mL),0 mL(0 mL, 400 mL) and 16 days(12 days, 30 days) in the SPD group respectively, with no significant differences between the 2 groups (Z =-1.185,-1.780,-0.533, P ＞0.05).There was no perioperative death and incidence of overall complication was 42.4％ (36/85) with pancreatic fistula, intra-abdominal infection and DGE as the top 3 common postoperative complications.The incidence of DGE was 20.5％ (9/44) in the PPPD group,which was significantly different from 4.9％ (2/41) in the SPD group (x2=4.571, P ＜ 0.05).The incidence of pancreatic fistula, biliary fistula, intra-abdominal infection, postoperative bleeding and 2 or more complications were 20.5 ％ (9/44), 2.3 ％ (1/44), 15.9％ (7/44), 4.5 ％ (2/44), 25.0％ (11/44) in the PPPD group, and 14.6％ (6/41), 4.9％ (2/41), 19.5％ (8/41), 7.3％ (3/41), 14.6％ (6/41) in the SPD group, respectively, showing no significant difference between the 2 groups (x2=0.495, 0.423, 0.295, 0.190, 1.425, P ＞ 0.05).Eighty-five patients were followed up for 6-47 months with a median time of 31 months, and postoperative overall 1-and 3-year survival rates were 95.3％ and 75.5％, respectively.The 1-and 3-year survival rates were 97.7％ and 78.9％ in the PPPD group, and 92.7％ and 71.7％ in the SPD group, respectively, with no significant difference in 3-year survival rate (x2=0.690, P ＞0.05).The 3-year overall survival rate was 80.5％ in patients without lymph node involvement (LNI) compared with 54.9％ in patients with LNI, showing a significant difference (x2=4.290, P ＜ 0.05).Conclusions Both PPPD and SPD have good short-term efficacy for periampullary carcinoma.There is no significant difference between PPPD and SPD concerning short-term survival rate of periampullary carcinoma.PPPD has shorter operation time, but has a higher postoperative DGE incidence.LNI is a significant prognostic factor for short-term survival of periampullary carcinoma.PPPD is not recommended while the lymph nodes are involved.
