摘要
目的探讨胆胰十二指肠结合部切除术治疗壶腹癌的临床疗效。方法18例壶腹癌患者,该术式切除范围:十二指肠降段,距胆胰管汇合部切除胰头1～2cm及胆总管至左右肝管汇合处下方。术中注意清扫区域淋巴结,术中冰冻病理证实各切缘无肿瘤残存。术后定期随访,统计并发症发生率、生存率、生存时间和肿瘤复发率等指标,进行临床疗效评价。结果全组手术成功率100%,术后未出现十二指肠漏、胆漏或明显胰漏等严重并发症,均痊愈出院。术后随访率为93.55%,随访时间为2个月～41个月不等,平均随访时间为13.6个月。本组目前共死亡5例:有2例因非手术并发症死亡,其中1例术后第8天出现急性心衰、肺水肿、严重肺部感染于术后1个月死亡;另1例死于术后2个月的应激性溃疡上消化道大出血;1例死因不明;2例死于肿瘤复发;其余26例均存活至今,其中有3例出现肝内或腹腔内淋巴结转移。结论胆胰十二指肠结合部切除术是治疗壶腹部癌的一种新术式,既比乳头局部切除术保证了相对足够的切除范围,又较常规胰十二指肠切除术明显降低手术难度和创伤程度。严格掌握手术适应证、彻底清扫区域淋巴结、保证各切缘无瘤残存和精细吻合是提高疗效的重要措施。
Objective Toevaluate the clinical application of Vater ampulla - duodenal conjunction resection in the treatment of periampullary carcinoma. Methods Thirty-one patients, of whom 18 had periampullary carcinoma, underwent this operation. In the operation, the descending part of the duodenum, Vater ampulla, partial head of the pancreas and common bile duct were excised as a whole. Regional lymph cleansing and cutting edge pathological examination were negative during the operation. The rate of complications, recurrence of tumor and survival were evaluated also. Results No severe complications appeared. The rate of postoperative follow-up was 93.55%, and the follow-up time was 2 to 41 months. In 5 patients who died postoperatively, 2 were due to non-operative complications, 1 to unknown reason, and 2 to tumor recurrence. In the remaining 26 patients survived, 3 had tumor recurrence. Conclusions As a novel operation, Vater ampulla-duodenal conjunction resection can not only reduce the wound caused by the operation and facilitate the maneuver, but also ensure a relatively radical resection.
出处
《中华普外科手术学杂志（电子版）》
2009年第1期33-35,共3页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
