摘要
目的 探讨胰头癌行胰十二指肠切除术并扩大淋巴结清扫（ELND） 的手术适应证及临床疗效。方法 总结2010年6月至2011年6月期间华中科技大学同济医学院附属协和医院胰腺外科收治的因胰头癌行胰十二指肠切除术并扩大淋巴结清扫21例患者的临床资料，其中男15例，女6例；年龄36～57岁，平均47.8岁。结果 21例中属Ⅰ、ⅡA、ⅡB及Ⅲ期者分别为3例（14.3%）、9例（42.9%）、8例（38.1%）和1例（4.8%）。R0切除者 18例（85.7%），R1切除者3例。切除淋巴结总数为14～43枚，平均为27.4枚；有淋巴结浸润者10例（47.6%）。平均手术时间为6.8 h （5～8.5 h），术中输血平均为5.6 U （3～8 U）。本组无手术死亡病例。5例（23.8%） 术后发生并发症；胰瘘3例（14.3%），胆汁漏 1例（4.8%），腹腔出血1例（4.8%），消化道出血1例（4.8%），顽固性腹泻2例（9.5%）。术后病理学检查结果高、中、低分化腺癌分别为6例（28.6%）、10例（47.6%）和5例（23.8%）。21例均获随访，随访时间5～40个月，中位随访时间为19个月；1、2及3年累积生存率分别为66.7%、38.1%和19.0%。结论 对可切除胰头癌选择性实施胰十二指肠切除并扩大淋巴结清扫术，有利于提高根治切除的比例及改善患者预后，但术后并发症发生率较高。
Objective To investigate the indications and clinical effect ofpancreatoduodenectomy with extended lymphadenectomy for pancreatic head carcinoma. Methods The clinical data of 21 patients with pancreatic head carcinoma that performed pancreatoduodenectomy with extended lymphadenectomy between June 2010 to June 2011 in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology were retrospective anal- yzed. The 21 patients included 15 men and 6 women with an age range of 36-57 years and an average age of 47.8 years. Results There were 3 cases （14.3%）, 9 cases （42.9%）, 8 cases （38. 1%）, and 1 case （4. 8%） in stage I , ]]A, ]TB, and Ill, respectively. Eighteen cases had a R0 resection （85.7%） and 3 cases had a R1 resection. The total number of resected lymph nodes were 14-43 with an average of 27.4. Lymph node invasion occurred in 10 cases （47.6%）. The average operative time was 6. 8 h （5-8.5 h） and the average amount of blood transfusion was 5.6 U （3-8 U）. There was no death in this group and 5 cases （23.8%） had postoperative complications. Tree cases （14.3%） developed pancreatic fistula, 1 case （4.8%） developed bile leakage, 1 case （4.8%） developed abdominal hemorrhage, 1 case （4.8%） developed gastrointestinal bleeding, and 2 cases （9.5%） developed intractable diarrhea. Postoperative pathological results in high, medium, and low differentiated adenocarcinoma was 6 cases （28.6%）, 10 cases （47.6%）, and 5 cases （23.8%）, respectively. Twenty one cases were followed-up, the follow-up time ranged from 5 to 40 months with a median time of 19 months. 1-, 2-, and 3-year cumulative survival rates was 66.7%, 38.1%, and 19%, respectively. Conclusion Selective application of pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head carcinoma is conducive to increase the proportion of the radical resection and improve the prognosis, but the postoperative complications is higher.
出处
《中国普外基础与临床杂志》
CAS
2014年第7期798-801,共4页
Chinese Journal of Bases and Clinics In General Surgery
基金
卫生公益性行业科研专项(项目编号:201202007)~~
