70岁以上高龄患者胰十二指肠切除术21例分析

Pancreaticoduodenectomy for periampullary cancer and pancreatic malignant neo- plasm in patients over 70 years

目的 探讨70岁以上高龄壶腹周围肿瘤患者施行胰十二指肠切除术的安全性和可靠性.方法 回顾性分析我院1998年至2009年收治的21例70岁以上患者胰十二指肠切除术的资料.结果 术前减黄5例.手术后近期死亡3例.8例发生一种或者多种并发症,均经积极治疗痊愈.术后再手术3例,均逐渐康复.术后1、3、5年生存率分别为61.11%、25.00%、12.50%.结论 高龄并非胰十二指肠切除术的禁忌.对重度黄疸的高龄患者术前减黄能显著改善肝功能,增加手术安全性;完善的围手术期管理非常重要;术中施行空肠造口意义不大;术中胃造口可以避免术后长期放置鼻胃管,对促进患者排痰、改善呼吸有利;术后早期一旦出现消化道或者腹腔大出血、严重的复合型消化道漏和腹腔感染,经短时间积极保守治疗无效时应尽快手术处理,可望挽救患者生命.

Objective To investigate the feasibility, efficacy and clinical prospects of pancreatieoduodenectomy（PD） for periampullary cancer and pancreatic malignant neoplasm in patients more than 70 years in age. Methods A total of 21 patients who were aged 70 years and older underwent pancreaticoduodenectomy in our hospital from 1998 to 2009. The clinical data were analyzed retrospectively. Results Five patients had undergone percutaneous transhepatic eholangial drainage（PTCD） before PD. Of the 21 patients, 3 died of liver failure and multiple organ failure shortly after operation; 8 developed postoperative complications, and were fully recovered by active medical treatment ; 3 underwent re - opera- tion and gradually recovered. Postoperative survival rates of 1,3 and 5 year（s） were 61.11% （ 11/18 ）, 25.00% （4/16）,and 12.50% （2/16） ,respectively. Conclusion Senility is not a eontraindieation for pancreaticoduodeneetomy. Preoperative biliary drainage can improve liver function and improve the safety of the operation. Perfect perioperative management is necessary and beneficial. Intraoperative enterostomy is not necessary. Gastrostomy can avoid postoperative detainment of gastric tube and facilitate expectoration and respiratory. Once severe complications emerge, such as incurable massive hemorrhage of gastrointestinal tract and peritoneal cavity, combined diffuse digestive leakage, extensive peritoneal infection and effusion, emergent surgical treatment should be carried out.