保留十二指肠升部的改良胰十二指肠切除术临床疗效分析

Clinical analysis of modified pancreatoduodenectomy with preservation of ascending portion of duodenum

目的通过比较保留十二指肠升部的改良胰十二指肠切除术与胰十二指肠切除术的治疗效果，探讨改良手术在壶腹部癌治疗中的价值。方法回顾性分析1990年至2006年山东大学齐鲁医院收治的133例壶腹部癌患者的临床资料。其中88例行胰十二指肠切除术（经典手术组），45例行保留十二指肠升部的改良胰十二指肠切除术（改良手术组）；通过Fisher确切概率法、t检验、χ^2检验、Log-rank检验比较两组患者术前情况及术后近期和远期疗效，探讨两种手术方式在治疗效果上的差异。结果经典手术组和改良手术组的手术时间分别为（366±111）min和（325±32）min，两组比较差异有统计学意义（t=2．34，P〈0．05）；术中输血比例分别为76％（67／88）和42％（19／45），两组比较差异有统计学意义（χ^2=14．99，P〈0．05）。两组患者术后主要并发症发生率比较差异无统计学意义（P〉0．05）。经典手术组和改良手术组胃肠道功能的恢复时间分别为（7．4±1．4）d和（4．3±1．4）d，两组比较差异有统计学意义（t=2．08，P〈0．05）；住院时间分别为（24±9）d和（31±14）d，两组比较差异有统计学意义（t=1．98，P〈0．05）。经典手术组和改良手术组中位生存时间分别为（19．0±1．5）个月和（16．9±1．7）个月，两组比较差异无统计学意义（χ^2=0．46，P〉0．05）。结论保留十二指肠升部的改良胰十二指肠切除术可用于壶腹部癌患者的治疗。

Objective To investigate the value of modified pancreatoduodenectomy in the treatment of ampullary carcinoma by comparing the efficacy of pancreatoduodenectomy with preservation of ascending portion of duodenum and that of Whipple procedure. Methods The clinical data of 133 patients with ampullary carcinoma who had been admitted to the Qilu Hospital from 1990 to 2006 were retrospectively analyzed. Of the 133 patients, 88 received Whipple procedure （group A） and 45 received pancreatoduodeneetomy with preservation of ascending portion of duodenum （ group B）. The preoperative condition of the patients and short- and long-term efficacy of the 2 procedures were compared by Fisher exact probability, t test, chi-square test, Kaplan-Meier survival curve and Log-rank test, and the differences between the efficacy of the 2 procedures were compared. Results The operation time, time of gastrointestinal function recovery, hospital stay and ratio of patients with blood transfusion were （366±111）minutes, （7.4 ±1.4）days, （24 ±9）days and 76% （67/88） in group A, and （325 ± 32） minutes, （4.3 ± 1.4） days, （ 31 ± 14） days, 42% （ 19/45 ） in group B, with significant difference between the 2 groups （ t = 2.34, 2.08, 1.98 ; χ^2 = 14. 99, P 〈 0.05 ）. The medium survival time of patients in groups A and B were （ 19.0 ± 1.5 ） months and （ 16.9 ± 1.7 ） months, with no signifieant difference between the 2 groups （χ^2 = 0. 46, P 〉 0.05 ）. There was no significant difference in the occurrence of postoperative eomplieations between the 2 groups （ P 〉 0.05 ）. Conclusions Pancreatoduodeneetomy with preservation of ascending portion of duodenum can be applied for patients with ampullary carcinoma.