255例胰头癌外科治疗的临床分析

Clinical analysis of pancreatic cancer surgical treatment in 255 cases

目的探讨胰头癌外科治疗的方法与疗效。方法回顾性分析255例胰头癌患者施行手术的病例。根治性切除术153例中,胰十二指肠切除术128例,扩大胰十二指肠切除术20例,全胰切除术5例;姑息性手术102例中,胆肠Roux-Y吻合术33例,胆肠T管架桥内引流术69例。结果手术切除率在20世纪70年代为10%,80年代为20%,90年代为30%。手术并发症3个年代分别为50%、30%、20%。尤其是胰漏发生率自20世纪70年代的25%到90年代明显下降为5%。手术死亡率3个年代分别为15%、8%、5%,而5年生存率则从20世纪70年代的5%、80年代的8%提高到90年代的10%。结论手术操作的不断改进和积累,术前对病情的评估和准备以及术中和术后的综合治疗是提高效果的关键。

Objective To explore the effect of the surgical treatment of pancreatic cancer. Methods A total of 255 cases operations were retrospective analyzed. Radical excision 153 cases, of which 128 cases in pancreatoduodenectomy,20 cases in the expansion of pancre- atoduodenectomy, and 5 in total pancreatectomy; 102 cases with palliative operation, of which 33 cases in Roux-Y biliary-enteric anastomosis,69 cases in the Roux-en bridge T tube drainage. Results Surgical resection rate in the 70＇ s was 10%, 20% in the age of 80 and 30% in 90＇ s. Complications during the surgery were respectively 50% ,30% and 20%. In particular, the incidence of pancreatic leakage from the age of 70 of 25% decreased to 5% in 90＇ s. Surgical mortality in all age were 15%, 8% and 5%, while the 5-year survival rate from 5%, 8% to 10% of the 90＇ s. Conclusion The key to the operation is continuous improving the operative procedure, evaluating before the operation and combined therapy in and after the operation.