根治性切除治疗胰头癌的手术体会

Experience in Radical Excision of Carcinoma of Head of Pancreas (Report of 55 Cases)

目的总结提高胰头癌手术根治率和降低术后并发症发生率的经验。方法回顾性分析我院1996年1月至2005年3月期间的55例胰头癌根治术患者的临床资料。结果本组55例胰头癌根治性切除术患者中男31例,女24例,均为胰腺导管癌。2002年前、后根治率分别为25.9%(29/112)和34.7%(26/75),并发症发生率分别为48.3%(14/29)和19.2%(5/26)。提高根治性手术技巧包括胰周淋巴结及神经丛清扫、联合血管切除、综合无血术野技术等。结论提高胰头癌手术根治率和降低术后并发症发生率有赖于对胰头癌病理生理特点的深入了解和手术技巧的成熟。

Objective To summarize the experience in radical excision of carcinoma of head of pancreas in or der to improve the surgical skills and reduce the occurrence of postoperative complications. Methods The clinical material of 55 patients （ages： 32--72 years; mean age： 56.5 years） With carcinoma of head of pancreas who received radical excision from January 1996 to March 2005 were analyzed retrospectively. All the cases were pathologically verified as ductal adenocarcinoma of head of pancreas. The treatment time following the operations was divided into two phases by year 2002 （ phase Ⅰ ： 1996--2002; phaseⅡ： 2002--2005）. Different surgical treatment groups were fixed and ICU and other measures were implemented during the second phase. Results All the patients, consisting of 31 males and 24 females, underwent consecutive extended resection. The radically curative rates of phase Ⅰ and phaseⅡ were 25.9% （29/112） and 34.7% （26/75）, respectively, and the complication rates were 48. 3%（14/Z9） and 19.2% （5/26）, respectively. A variety of surgical skills would improve the operation, including extended regional lymphadenectomy, resection of involved nerve plexus, combined vessel resection and comprehensive bleedingcontrol technique and so on. Conclusion The improvement of radically curative effect and the reduction of complica tion rate depend on the advancement of surgical skills and the further understanding of pathophysiology of carcinoma of head of pancreas.