进展期胰头癌并门静脉及肝转移外科治疗回顾性研究

Retrospective study on surgical treatment of progressive pancreatic head cancer with metastasis of portal vein and liver.

目的探讨进展期胰头癌并门静脉及肝转移扩大根治切除与改良术式，以提高切除率、生存率及生活质量。方法以美国癌肿联合委员会（ALCC）TNM分期标准入选的胰腺癌住院患者为受术对象，选择胰头癌剖腹探查60例，其中27例扩大根治合并门静脉转移部分切除19例，肝左叶及肝右叶肝段切除8例，采用改良Whipple术式间置空肠Y形重建消化道和门静脉血管重建；27例术后分介入灌注化疗治疗组13例和对照组14例。结果27例术后均无严重并发症及手术死亡，治疗组和对照组2、3、5年生存率分别为61．5％、38．4％、23．0％和42．8％、21．4％、14．3％。治疗组和对照组生存率差异有统计学意义（P均〈0．05）。结论扩大根治切除与改良术并术中、术后介入化疗可显提高生存率和改善生活质量。

Objective To retrospeetivley explore the expanded radical reseetable range and improved surgical approach of the progressive pancreatic head cancer with metastasis of portal vein（PV） and liver, and try to improve the resectable rate, survival rate and quality of life. Methods The patients with late pancreatic cancer classified by ALCC TNM were selected as subjects, in which 60 cases were given laparotomy. 19 cases with metastasis of partial PV resection and 8 cases of left leaf or right leaf sectional hepatectomy partial were involved in 27 cases, reconstructed gastrointestinal tract with improved Whipple interposed Y-type jejunostomy and PV. 27 cases were randomly divided into intervention chemotherapy of treatment groups （n = 13 ） and control groups （n = 14 ）. Results Severe complications or dead cases were not found in 27 cases after operation. The 2-, 3-,5-years survival rates were 61.5% ,38.4% ,23.0% ,and 42.8% ,21.4% ,14.3% in treatment group and control group,respectively. The survival rate was statistically different（ P 〈 0.05 ）. Conclusions The expanded radical pancreatoduodenectomy and its improved surgical approach can improve not only the survival rate but also the quality of life.