摘要
目的 探讨改良的Appleby手术治疗胰体尾癌的安全性、可行性和临床效果.方法 2010年3月至2015年2月河南省人民医院肝胆胰腺外科采用保留胃的改良Appleby手术治疗胰体尾肿瘤患者17例,其中男10例,女7例,年龄46 ～ 69岁,平均年龄（58±8）岁.观察手术前后可能出现的并发症,疼痛评分,生活质量评估,肝功能,血糖等诸项指标的变化.评估患者术后复发转移情况及生存期等.结果 本组患者无手术相关死亡病例,主要并发症为胰漏和腹泻,总的并发症发生比率为47.1％,术后1d肝功能指标丙氨酸转氨酶（ALT）,天冬氨酸转氨酶（AST）等升高,1周后恢复正常,血糖无明显异常升高.腹痛获得完全缓解,疼痛评分降低,生活质量评估明显升高.术后1、2、3、5年复发转移率为22.9％、58.9％、72.6％、72.6％.中位复发转移时间：（20.0±3.8）个月（95％可信区间12.6 ～27.4个月）.1、2、3、5年生存率为80.4％、54.2％、32.5％、16.3％.中位生存时间：（26.0±6.0）个月（95％可信区间14.2 ～37.8个月）.结论 改良的Appleby手术治疗胰体尾癌是安全可行的,可确切缓解腹痛,提高生活质量,有助于提高患者生存率,延长生存时间.
Objective To evaluate the security,feasibility and therapeutic efficacy of modified Appleby operation for carcinoma of the body and tail of pancreas.Methods From March 2010 to February 2015 modified Appleby operation was performed in 17 patients with carcinoma of the body and tail of the pancreas.The biochemical indices of fasting plasma blood （FPB）,body weight （BW）,visual analogue pain intensity scale （VAS score） and the quality of life index were evaluated before and 1 day,1,2,6weeks after surgery.Survival time,tumor recurrence time,hospitalization time and treatment-related complications were analyzed.Results There was no hospital mortality in this study.Pancreatic fistula and diarrhea were the major complications.The overall complication rate was 47.1%.The liver function index of ALT and AST were increased on postoperative day 1,and they were restored to normal after one week.Blood glucose has no obvious abnormal increase and abdominal pain was completely relieved.The VAS score decreased after surgery comparing with before （1.9 ± 3.6 vs 83.2 ± 8.5,P 〈 0.05）.Life quality assessment was significantly higher.The body weight of patients after surgery has a mean increment of （4.1 ± 1.3）kg than that before surgery （68.1 ± 4.3 vs 64.0 ± 6.7,P 〈 0.05）.A significant rise of the overall quality of life index was observed after surgery （93.8 ±9.7 vs 68.6 ±6.7,P 〈0.05）.The recurrence rates of 1,2,3 and 5 years were 22.9%,58.9%,72.6% and 72.6%,respectively.Median recurrence time was （20.0 ±3.8 m） （95% CI：12.6-27.4 m）.The survival rates of 1,2,3 and 5 years were 80.4%,54.2%,32.5% and 16.3%,respectively.The median survival time was （26.0 ±6.0） m （95% CI：14.2-37.8 m）.Conclusions Modified Appleby operation for pancreatic cancer is safe and feasible.It can relieve abdominal pain,improve the quality of life,improve the survival rate and prolong the survival time.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2016年第6期431-434,共4页
National Medical Journal of China
关键词
胰腺肿瘤
外科手术
疼痛
Pancreatic neoplasms
Surgery
Pain
