胰腺导管癌扩大和根治性全胰切除术的探讨

Curative Total Pancreatectomy for Ductal Adenocarcinoma of the Pancreas

目的:探讨胰腺癌根治性全胰切除的疗效.方法:1970年～1994年对21例胰腺导管癌(按Kl(?)ppel分期:T_(1-2)N_0M_010例,T_(1-3)N_(0-2)M_08例及T_(1-3)N_(1-2)M_03例)施行根治性全胰切除术,包括胰周、区域性淋巴结及后腹膜间隙组织廓清/和有侵犯的门静脉切除.结果:区域性淋巴结阳性占52.3%,胰后血管粘连或侵犯占26.6%,胰腺多病灶癌占19%.本组无手术死亡率,生存期平均56个月.结论:根治性全胰切除方法对提高生存期有积极作用,适用于Ⅰ、Ⅱ期病例.

Objective: To study the outcome after total pancreatectomy for ductal adenocarcinoma of the pancreas. Methods: Twenty-one patients with ductal adenocarcinoma of the pancreas treated by total pancreatectomy during the period 1970~1994 were reviewed. Their staging according to Kloppel: T1-2N0M0,10 cases;T1-2N0-2M0,8 cases and T1-2N1-2M0, 3 cases Total Pancreatectomy was accompanied by extended dissection of juxtapancreatic and regional lymph nodes, with en bloc resection of ret-roperitoneal connective tissues and skeletonization of major vessels. Concomitant resection followed by reconstruction of the portal vein was carried out if it was invaded by cancer. Results: There was no operative mortality in our series, and the mean survival time was 56 months. The tumor was multifocal in 19% of the patients, the retropancreatic vessels were encroached by the tumor in 26.6% of the cases, and 52.3% of the lymph nodes were involved. Conclusions: Curative total pancreatectomy is useful, safe and expeditious procedure for the treatment of ductal adenocarcinoma. It is indicated for stage I and II carcinomas.