胰头癌的外科治疗:附142例报告

The surgical treatment of pancreatic cancer:a report of 142 cases

目的探讨胰腺癌的外科治疗方法对其生活质量、生存时间的影响,以总结胰头癌的外科治疗经验。方法回顾性分析1997年1月—2007年12月142例经手术治疗的胰头癌患者的临床及随访资料,142例分为根治性切除(RR)组(38例),姑息性切除(PR)组(15例),胆肠内引流(BJ)组(89例)。BJ组根据吻合方式再分为胆囊空肠吻合组(56例),胆管空肠吻合组(33例);是否附加胃空肠吻合又分为BJ+胃空肠吻合组(32例),BJ未附加胃空肠吻合组(57例)。观察各组生存时间及BJ组黄疸复发率、十二指肠梗阻发生率。结果(1)RR,PR,BJ组的中位生存时间分别为13.6,10.7,7.8个月,RR组生存时间较PR,BJ组有明显延长(P<0.01),但PR组与BJ组生存率相比,差异无统计学意义(P>0.05)。(2)BJ组中胆管空肠吻合组生存率显著高于胆囊空肠吻合组(P<0.05);胆囊空肠吻合组、胆管空肠吻合组黄疸复发率分别为55.4%,9.1%(P<0.01)。附加胃空肠吻合组、未附加胃空肠吻合组十二指肠梗阻发生率分别为6.2%,22.8%(P<0.05)。结论胰腺癌患者应首选根治性切除;对不能行根治性切除者宜选择胆管空肠、胃空肠双吻合手术,以期提高其生活质量、延长生存期。

Objective To investigate the effect of various operative methods for pancreatic cancer on patient ＇ s quality of life and survival time. Methods The clinical data of 142 patients with pancreatic cancer admitted into our hospital between 1997 and 2007 were analyzed retrospectively. The patients were divided into 3 groups ： Undergoing radical resection （ RR, n = 38 ） , palliative resection （ PR, n = 15 ） and biliary-jejunostomy （BJ, n = 89 ）. The BJ patients were subdivided into cholecystojejunostomy group （n = 56 ）, choledoehojejunostomy group （ n = 33 ） , gastrojejunostomy group （ n = 32 ） and no-gastrojejunostomy group （ n = 57 ） according to the differen methods of anastomosis. SPSS13.0 software package was used for survival analysis, the recurrence rate of jaundice and obstruction of duodenum. Results The median survival time in patients undergoing RR, PR and BJ was 13. 6,10. 7 and 7. 8 months respectively. RR group had longer survival time than PR and BJ group （ P 〈 0.01 ） . Meanwhile, PR group had longer survival time than BJ group, but the difference was no statistical （ P 〉 0. 05 ） The patients receiving choledochojejunostomy had longer survival time than the patients undergoing choleeystojejunostomy （ P 〈 0.05 ） . Moreover, the former had lower recurrence rate of jaundice than the latter （ P 〈 0.01 ）. The gastrojejunostomy group had lower rate of duodenumal obstruction （ P 〈 0. 05 ） . Conclusions Radical resection should be regarded as the first choice for the patients with pancreatic cancer. For those patients who cannot urdergo radical resection, the selection of biliary-jejunostomy and gastrojejunostomy （ double bypass ） is more conducive to better quality of life and longer survival time.