老年二期胰十二指肠切除4例及一期联合结肠癌根治术1例

An analysis of four cases of second-stage pancreaticoduodenectomy and one case of combined first-stage pancreaticoduodenectomy and sigmoid cancer radical operation in aged patients

目的:探讨一期未能切除的老年壶腹周围恶性肿瘤患者和结肠癌根治切除术后胰头区转移癌患者行胰十二指肠切除术的可行性和手术特点.方法:4例恶性梗阻性黄疸患者中,2例一期手术施行胆囊切除术、胆总管探查术、T型管引流术,另2例一期手术施行胆管空肠吻合术,待黄疸减退、肝功能好转后,二期手术施行胰十二指肠切除术.1例结肠癌根治术后19年再次发现乙状结肠癌及胰头区转移癌,随后同时成功实施胰十二指肠切除术及乙状结肠癌根治术.分析患者生存情况.结果:5例患者中,有1例胆总管引流近2mo后在外院拔除T管,拔管后出现黄疸及胆管炎表现,逐渐加重,再次来我院就诊后很快实施了胰十二指肠切除术,术后10d死于肝肾功能衰竭.其余4例术后逐渐康复,术后定期化疗,分别生存32、41、58、79mo,其中存活58mo的1例患者目前仍健康存活.结论:一期未能切除的老年壶腹周围恶性肿瘤患者及结肠癌根治切除术后胰头区转移癌患者,行胰十二指肠切除术仍能显著延长患者生命,改善生活质量.

AIM： To evaluate the feasibility and operative characteristics of second-stage pancreaticoduodenectomy （PD） for initially unresectable periampullary cancer and for metastatic pancreatic carcinoma after radical excision of colon carcinoma in senile patients. METHODS： A total of five senile patients were included in the study. Four patients had malignant obstructive jaundice, of which two underwent first-stage cholecystectomy, common bile duct exploration and T-tube drainage, and the other two underwent cholangiojejunostomy. After jaundice subsidence and liver function recovery, these patients underwent second-stage PD. Another senile patient simultaneously underwent PD and radical resection of sigmoid colon due to cancer recurrence and metastatic pancreatic carcinoma 19 years after initial cancer radical resection. RESULTS： One patient underwent first-stage T-tube drainage for two months and developed jaundice and cholangitis after T-tube withdrawal. Due to gradual exacerbation, he underwent second-stage PD but died of liver and renal failure 10 days after the operation. The other four patients recovered gradually after PD, underwent regular postoperative regular chemotherapy, and survived for 32, 41, 58 （still alive） and 79 months, respectively. CONCLUSION： PD is indicated for aged patients with initially unresectable periampullary cancer or metastatic pancreatic carcinoma after radical excision of colon carcinoma, and can significantly prolong their life span and improve their life quality.