晚期胰头癌扩大根治术的外科临床研究

The Clinical Study Expanded Eradicative Operation for Surgical Treatment of Late Pancreas Head Cancer

目的：以晚期胰头癌患者为手术对象，探讨扩大根治与改良术式，提高切除率及生存率和质量。方法：选择性剖腹探查２０例，其中１８例作了扩大根治，采用门脉血管重建及改良ＣｈｉＩｄ术式间置空肠Ｙ形重建消化道加人工乳头定向套迭。结果：扩大根治切除率为９０％，术后均无胆、胰瘘、大出血等严重并发症及手术死亡，最长生存期达５年，２年存率为５５．６％。结论：切除了原发病灶可以解除病人症状，又可防止癌细胞继续浸润门静脉。一并切除了转移灶，使后续治疗（如腹腔动脉化疗、免疫等）得以顺利进行。

Objective:Studies on the expanded eradicative and modified operation for treatment in patients of late pancreas head cancer, in ordet to enhance the incised rate, survival rate and life quality.Methods:The elective laporotomy was done in 20 patients. Expanded eradicative operation was performed in 18 patients among them ,We have reconstructed the portal vein,modified the Child operation,reconstructed the elememtary tract using Roux-Y interposed jejunum with orientatied intussusception of artificial papilla.Results:The incised rate of expanded eradication was 90% without postoperative serious complications such as biliary and pancreatic leakage,massive hemorrhage and operative death.The longest survival time is 5 years.Two years survial rates was 55.6%.Conclusions:(1)The incision of original carcinomous focus may relieve the patient's symptoms and can prevent portal vein from carcinomous cell infiltration.(2)After enbloc incision with metastatic focus,the sequential treatment could carry ont successfully.