摘要
目的:探讨胰头癌的外科治疗.方法:因术前临床诊断胰头癌施行胰十二指肠切除术265例,其中行常规胰十二指肠切除术(WhiPPle)152例,保留幽门型胰十二指肠切除术(PPPD)75例,包括切除一段血管的胰十二指肠切除术19例,经再次手术行胰十二指肠切除术17例,全胰切除术2例.术前经B超、CT、选择性ERCP、穿刺细胞学检查,确诊232例(87.5%).术后经病理证实:胰头癌132例,壶腹癌77例,胆总管远端癌22例,十二指肠癌16例,转移癌1例和良性病变17例(慢性胰腺炎14例和良性肿瘤3例).结果:术后发生并发症118例(47.6%),住院死亡10例(4%).PPPD术后并发胃排空障碍较其它术式显著增高(P<0.01).结论:由非胰腺专业组医师施行的手术死亡率明显高于专业组医师(P<0.05),只要病例选择恰当,围手术期良好的处理,可以继续降低手术死亡率.
Objective: To investigate the surgical treatment for carcinoma of pancreatic head. Methods: Two hundred and six-five pancreaticoduodenectomies had been performed in our hospitals from May 1985 to Oct. 1997. There were 152 Whipple operations, 75 PPPDs, 19 Whipple combined with segmental resection of the porto-superior mesenteric vein, heptic or superior mesenteric artery, 17 reoperative Whipple resections and 2 total pancreatectomies. All procedures, except 27, were performed by hepatobiliary pancreatic(HBP) surgeons. Before operation, diagnosis was established by B-US, CT, ERCP, FNAB and tumor marker CA19-9 in 232 patients(87.5%). There were 132 cases of carcinoma of the head of the pancreas, 77 ampullary carcinomas, 22 carcinomas of the distal common bile duct, 16 duodenal carcinoma, 1 matastatic carcinoma in the head of pancreas, and another 17 benign diseases confirmed by pathologic examination. Results: The postoperative morbidity and mortality were 46.8% and 3.8%, respectively. The morbidity of delayed gastric emptying of PPPD was much higher than that of other operations (P<0.01). Conclusions: Both operative morbidity and mortality practiced by of non-HBP surgeons were much higher than those of HBP surgeons (P<0.05). HBP surgeons could markedly increase the re-sectable rate of pancreatic carcinoma and reduces both postoperative morbidity and mortality.
出处
《外科理论与实践》
1998年第2期95-97,共3页
Journal of Surgery Concepts & Practice
关键词
胰头癌
胰十二指肠切除术
手术治疗
Pancreatic carcinoma Pancreaticoduodenectomy Surgical treatment
