改良Whipple术式与扩大根治术治疗晚期胰头癌的临床应用

Clinical application of expanded radical operation with improved Whipple technique to late pancreas head cancer

作者以晚期胰头癌患者为受术对象，探讨扩大根治与改良术式，提高切除率及生存率和质量。选择性剖腹探查３３例行扩大根治术，采用门静脉血管重建及改良Ｗｈｉｐｐｌｅ术式间置空肠Ｙ形重消化道加人工乳头定向套迭３０例，其中合并门静脉部分切除１９例、肝左外侧叶及肝段切除８例、横结肠中段切除３例。结果显示：扩大根治切除率为９０％，术后均无胆胰瘘、大出血严重并发症及手术死亡。至今生存２３例，平均２年生存率为５０％，最长者达５年。作者认为：（１）切除了原发病灶，可以解除患者症状，又可防止癌细胞继续浸润门静脉。（２）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，明显提高了生存期和质量。

Studies on the expanded eradicative and modified operation for treatment in patients of late pancreas head cancer,so as to enhance the incised rate,survival rate and life quality. Elective laparotomy was done in 20 patients.Expanded eradicative operation was performed in 18 patients (portal vein excision 19,left outer leaf of liver 8,transverse colon 3).We have reconstructed the portal vein 6,modified the Whipple operation,reconstructed the elememtary tract using RouxY interposed jejunumwith orientatied intussusception of artificial papilla. 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 was 5 years.The twoyear survival rate was 50%. Statistical analysis(t test and x2 )showed signithicant differences(P<0001).:(1)The exsion 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, sequential treatment could be given successfully.