胰十二指肠切除术治疗胰头和壶腹部癌230例分析

Pancreatoduodenectomy for Cancer of the Head of Pancreas and Cancer of Ampulla of Vater: Analysis of the 230 Patients

了解胰十二指肠切除术治疗胰头和壶腹部癌的效果和影响病人生存的因素。方法:分析230例胰头和壶腹部癌的主要表现,辅助检查、手术并发症、手术死亡率,调查术后生存情况及影响病人长期生存的因素。结果:本组病人出现黄疽90.9％,腹痛56.1％,发热32.6％,白陶土样大便13.5％。B超、CT和ERCP检查准确率分别为68.3％、79.3％和66.6％。手术并发症72例(31.3％),死亡20例(8.7％)。术后1、3、5年存活率分别为46.7％,17.4％和52％。肿瘤直径、淋巴结转移和切缘状态是影响病人术后生存的因素,而肿瘤分化程度和病人年龄对生存率无明显影响。结论:胰头和壶腹部癌临床表现有多样性,B超和CT等辅助检查有局限性,手术有高并发症,5年生存率低下,手术治疗远近期效果都不理想。

Aims:To review the effects and factors influencing survival after pan-creatoduodenectomy in patients with cancer of the head of the pancreas and cancer of the ampulla of Vater. Methods: 230 patients with pathologically verified cancer of the head of the pancreas and cancer of ampulla of Vater underwent pancreatoduodenectomy and were followed up. The clinical symptoms, the supplementary examinations, the operative complications, mortality, the survival rate and factors influencing survival were analyzed. Results: The main symptoms were jaundice(90.9%), abdominal pain(56.1%), fever(32.6%), and white stool(13.5%). The accurate rate of B ultrasonography, CT and ERCP were 68.3%, 79.3% and 66.6%, respectively. The operative complication rate and mortality was 31.3% and 8,7%. The 1, 3, and 5-year survival rate were 46.9%, 17.4%, and 5.2%, respectively. The diameter of the tumor, the metastasis of lymph nodes, the status of the resection margins were the factors influencing survival, while the histologic grade of the tumor and the age of the patients were no influence. Conclusions: These results indicated the long-term and short-term effect of pancreatoduodenectomy for carcinoma of the head of pancreas and carcinoma of ampulla of Vater was not very gratified.