胰腺专业组与非专业组胰十二指肠切除之比较：432例临床分析

Comparison of pancreatic specialty group with non-pancreatic specialty group in performing pancreaticoduodenectomy:a clinical analysis of 432 cases

目的探讨胰腺专业组与非专业组胰十二指肠切除术(PD)有无差别。方法回顾性分析我院自1986年成立胰腺专业组以来至2006年8月432例胰十二指肠切除术资料,其中专业组行PD 324例,非专业组行PD 108例。结果专业组与非专业组手术切除率、切缘阳性率、胰瘘发生率、平均切除肿瘤大小、平均清除淋巴结数、平均术中输血量、平均手术时间、术后平均住院时间、术后平均生存期、手术死亡率分别为44.9%、7.10%、2.78%、3.19 cm、10.11、770 ml、5.7 h、15.4 d、27.7个月、1.23%和30.0%、16.67%、12.96%、2.67 cm、5.69、1210 ml、5.18 h、23.4 d、19.9个月、8.33%,有显著性差异(P<0.05或P<0.01),而在胆瘘、出血、胃潴留、感染方面无显著性差异。结论①宜成立胰腺诊治中心或专业组,集中收治胰腺病人,以提高手术安全性和规范性。②主张根治术和扩大根治术,提高疗效。

Objective To determine whether there are differences between the results of pancreaticoduodenectomy performed by pancreatic specialty group （PSG） and those by non pancreatic specialty group （NPSG）. Methods The medical records of 432 patients underwent pancreaticoduodenec tomy from 1986 when PSG was established to August 2006 were retrospectively analyzed. The operation was done by PSG in 324 patients and by NPSG in the left 108. Results The surgical resection rate, positive rate of resection margin, pancreatic fistula rate, average excised tumor size, average number of dissected lymph nodes, average volume of blood transfusion in operation, average operative duration, average postoperative hospitalization duration, average postoperative survival time and operative mortality were 44.9%, 7, 10%, 2.78%, 3.19 cm, 10, 11, 770 ml, 5.7 h, 15.4 d, 27, 7 months and 1,23% in PSG while 30.0%, 16,67%, 12,96%, 2,67 cm, 5,69, 1210 ml, 5.18 h, 23.4 d, 19,9 months and 8.33% inNPSG, respectively （P〈0.05 or 0.01）. However, there were no signifi cant differences in bile fistula occurrence, gastrointestinal and intraabdominal hemorrhage, gastroparalysis and infection between the 2 groups, Conclusion It is advisable to establish pancreatic center or PSG to improve operative safety and standardize the procedure of panereatieoduodeneetomy. It is our suggestion to perform radical or extended radical panereatieoduodenectomy for periampullary cancer.