晚期胰腺癌的姑息性手术切除附20例应用体会

Conservative Resection of Pancreatic Head Cancer: with 20 Cases Application Analyses

目的比较中晚期胰头肿瘤的不同治疗方法,包括姑息性手术切除与常规改道手术,结合局部化疗及内照射放疗,观察患者预后的改善情况。方法回顾分析我科2002年1月～2004年10月治疗65例胰腺癌患者的情况。结果同期胰腺癌手术65例;其中根治性切除18例,姑息性切除20例,姑息性转流手术27例,总的切除率为58.46%(38/65)。根治性切除患者生存期为6～34个月,平均(23.6±7.2)个月;姑息性切除患者生存期为4～26个月,平均(15.3±6.6)个月;姑息转流手术患者生存期为4.2～16个月,平均(8.2±4.6)个月。统计学显示三者间有显著差异(P<0.01),反映姑息性切除较单纯姑息性手术在预后方面有一定的改善。结论对于中晚期胰头肿瘤术中不轻言放弃,适当应用姑息性胰腺癌切除手术,配合局部的放化疗能够在一定程度上改善中晚期胰腺癌患者的预后,值得进一步研究观察。

Objective To compare the different therapeutic procedures in the treatment of advanced pancreatic head cancers including conservative resection and routine bypass procedure combined or not combined with local chemotherapy and radiotherapy. Methods The results of the 65 patients with pancreatic cancer who underwent radical resection or conservative resection or conservative bypass procedures were reviewed and analyzed. Results Of the 65 patients, 18 patients underwent radical pancreatoduodenectomy (RPD), 20 patients underwent conservative pancreatoduodenectomy (CPD), and 27 patients underwent conservative bypass procedures (CBP). The total resection ratio was 58.46%. The survival time of different procedures ranged as 6 to 34 months (23.6±7.2) for RPD, 4 to 26(15.3±6.6) months for CPD and 4.2 to 16(8.2±4.6) months for CBP, respectively (P<0.01). Conclusion The resection procedure should not be abolished rashly in advanced pancreatic cancer patients. And suitable selection of conservative resection of pancreatic cancer has beneficial effect in the survival time of the patients when combined with local chemotherapy and radiotherapy. Further study is needed.