摘要
目的探讨根治性胰十二指肠切除术在壶腹周围癌(AVC)中的临床治疗价值。方法回顾性分析我院1995年3月至2009年3月期间收治的195例AVC患者的临床资料,根据治疗方式分为非手术组(n=51)、姑息性手术组(n=96)和手术切除组(n=48).结果手术切除组术后1、3及5年生存率较姑息性手术组及非手术组明显提高(P<0.01),但手术切除组的并发症发生率较姑息性手术组和非手术组明显升高(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末段癌及十二指肠乳头癌患者明显降低(P<0.01),并且胰头癌患者1、3及5年生存率也明显低于胆总管末段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1、3、5年生存率差异均无统计学意义(P>0.05).各组中年龄>70岁与≤70岁者的并发症发生率差异无统计学意义(P>0.05);但手术切除组年龄>70岁者的围手术期死亡率明显高于≤70岁者(P>0.05).结论外科手术切除仍然是治疗AVC的重要手段,尤其根治性胰十二指肠切除术是治疗壶腹周围癌的惟一有效方法,可以明显延长患者术后存活期,提高其生存质量。
Objective To explore the clinical therapeutic value of pancreatoduodenectomy in patients with carcinoma of ampulla of Vater （AVC）. Methods The clinical data of 195 patients with AVC between March 1995 and March 2009 in this hospital were analyzed retrospectively. All the patients were divided into non-surgery group （n=51）,palliative surgery group （n=96）,and resection group （n=48） according to the treatment methods. Results The 1-year,3-year,and 5-year survival rates in the resection group were higher than those in the non-surgery group and the palliative surgery group （P0.01）. However,the incidence of complications in the resection group was higher than that in the non-surgery group or the palliative surgery group （P0.05）. The radical resection rates,1-year,3-year,and 5-year survival rates of carcinomas of head of pancreas were significantly lower than those of carcinomas of the terminal of common bile duct or carcinomas of duodenal papilla （P0.05,P0.01）. There was no significant difference of the perioperative mortality,complications rate,1-year,3-year,or 5-year survival rate between preoperative drainage jaundice group and preoperative non-drainage jaundice group （P0.05）. The perioperative mortality in the resection group above the age of 70 years old was higher than that of less than or equal to 70 years old （P0.05）. Compared with the non-surgery group or palliative surgery group,there were significant increasement of the incidence of serious or deadly perioperative complications in the resection group （P0.05）. Conclusions Surgical resection remains one of the most important measures of the treatment of AVC,in particular,the radical pancreatoduodenectomy is the only effect way for AVC,thus significantly prolonging the patient＇s postoperative survivals and significantly improving the qualities of life.
出处
《中国普外基础与临床杂志》
CAS
2010年第9期944-950,共7页
Chinese Journal of Bases and Clinics In General Surgery
关键词
壶腹周围癌
十二指肠乳头癌
胰头癌
胆总管末段癌
根治性胰十二指肠切除术
Carcinoma of ampulla of Vater
Carcinoma of duodenal papilla
Carcinoma of head of pancreas
Carcinoma of terminal of common bile duct
Pancreatoduodenectomy
