摘要
目的 探讨胰头部肿瘤诊断及外科治疗特点。方法 2 77例胰头部肿瘤术前全部行B超 ,CT ,胃肠钡餐摄片检查及手术探查以明确诊断。对 80例接受胰十二指肠切除手术者按 1995年前 (A组 ,41例 )、后 (B组 ,3 9例 )分组 ,比较分析两组疗效。结果 手术治疗 194例 ,包括剖腹探查2 8例、胆肠吻合 /T管引流 86例 ;胰十二指肠切除 80例中 ,A组 (1982～ 1995年手术者 )手术时间、术中失血量、输血量、并发症发生率均显著高于B组 (1996年以后手术者 ) (P均 <0 .0 1)。围手术期死亡率 :A组 9.76% ,B组 0 % (P >0 .0 5 )。随访 :T管引流者平均生存 (4 .0 7± 1.80 )个月 ,胆肠吻合者平均生存 (8.2 8± 2 .3 1)个月 ,两者相比差异显著 (P <0 .0 0 1) ;胰十二指肠切除中A组平均生存 (17.97± 9.2 4)个月 ,B组平均生存 (2 2 .9± 11.3 0 )个月 (P >0 .0 5 )。结论 非结石性十二指肠“缩窄性乳头炎”、非结石性、非酒精性胰头部肿块 ,应高度警惕胰头部肿瘤的可能 ,要采用包括影像学 ,细针穿刺活检等明确诊断 ;对临床高度怀疑为癌者 ,应积极行剖腹探查 ,术中快速切片明确诊断。
Objective To investigate the diagnosis and treatment of tumor of the head of pancreas(THP). Methods The clinical data of 277 cases of THP were restrospectively reviewed. All patients were diagnosed by US,CT, gastroenteric barium meal and /or operation. A comparison was made in 80 cases , who underwent pancreatoduodenectomy were divided into group A(41 patients operated during1982-1995) and group B(39 patients operated after January,1996) . Results 194 patients underwent surgical treatment,including explore laparotomy in 28,bilioenterostomy or T tube drainage in 86,pancreatoduodenectomy(PTD) in 80.Among 80 cases treated with PTD, the operation time,blood loss volume and blood transfusion volume during operation, and serious postoperative complication occurring rate in group A were significantly higher than those in group B(all P<0.01). The mortality in group A was 9.76%,in group B was 0% (P> 0.05 ).The follow up results were as follows:the average survival time was (4.07 ±1.80) months in patients with bile external drainage, and (8.28 ±2.31) months in hepatojejunostomy,(P<0.001 ) ;the average survival time was (17.97 ± 9.24) months in pancreatoduodenectomy group A, and (22.9±11.30)months in group B,(P<0.0931). Conclusions Tumor in pancreas head should highly be suspected when non stone stenosing papillitis, a pancreas head mass are found in non alcohol and non stone patients, and the imageic examination and fine needle aspiration cytological examination should be adopted to make the diagnosis.If the patients is highly suspected as THP,an explore laparotomy should be done,and a intraoperation frozen section has to be done to comfirm the diagnosis.If the diagnosis of PHT is made,a PTD should be done,if possible.
出处
《中国普通外科杂志》
CAS
CSCD
2003年第10期769-771,共3页
China Journal of General Surgery
