壶腹周围肿瘤的再探查手术治疗(附58例报告)

Surgical reexploration for periampullary neoplasms: a report of 58 cases

目的:总结58例壶腹周围肿瘤再次手术探查的经验体会。方法:回顾性分析58例壶腹周围肿瘤病例再次手术的临床及预后资料。结果:再次手术距首次手术时间为0.75个月至9年,中位时间3个月。经术前影像学评估无肿瘤转移和胰周大血管包裹后由胰腺外科专业组医师再次手术,再切除率为91.4%(53/58),有3例联合肠系膜上静脉切除重建。手术死亡率为3.4%(2/58),术后并发症发生率为12.1%(7/58)。平均手术时间为(5.3±1.9)h;平均术中出血量为(1140±970)ml。随访表明:17例周围淋巴结转移术后存活9～18个月,平均(14.4±5.3)个月;无转移患者存活12～42个月,平均(28.2±15.8)个月。13例患者存活8～42个月,至今尚健在。结论:术前准确的影像学评估和手术医师的专业化是再探查切除肿瘤的关键,提高手术安全性可使再次手术切除肿瘤获得良好预后。

Objective： To sum up the experience in surgical reexploration of 58 patients with periampullary neoplasms.Methods： The clinical data of 58 patients with periampullary neoplasms undergoing surgical reexploration were analyzed retrospectively. Results：The interval between the first and second operation was from 0.75 months to 9 years, with a median of 3 months. Reexploration was carried out when imaging examination found no metastasis and peripanereatie vessel involvement.The reseetable rate of reoperation was 91. 4%, with postoperative mortality being 3. 4% and postoperative morbidity being 12.1%. The mean operative time was （5.30±1.9） h and the mean blood loss was （1 140±970） ml. Seventeen patients with lymph node metastasis survived for 9-18 months, with a mean of （14.4±5.3） months; those without lymph node metastasis survived for 12-42 months, with a mean of （28.2±15.8） months. Thirteen patients survived for 8-42 months and are still alive. Conclusion： Pre-operation imaging examination and experienced surgeons are the key factors for reexploration and resection of periampullary neoplasms. Improvement of surgical safety can secure better prognosis after reexploration and resection.