不能切除的老年胰头癌患者行不同减黄方式的对比研究

Contrastive Study on Different Palliation for Elderly Patients with Unresectable Pancreatic Head Cancer

目的探讨对于不能切除的胰头癌老年患者行外科手术减黄的安全性和有效性。方法回顾性分析2002年7月至2009年6月期间在我科因患有不能切除的胰头癌而行姑息性治疗的55例患者的临床资料,根据不同年龄和治疗方法患者分为以下3组:A组(年龄≥65岁,n=19),行外科手术转流胆汁减黄;B组(年龄<65岁,n=19),行外科手术转流胆汁减黄;C组(年龄≥65岁,n=17),仅接受PTBD减黄,对各组患者治疗结果进行分析。结果 A组患者与B组比较,术后血胆红素水平、早期并发症发生率、术后平均住院时间及平均生存时间的差异均无统计学意义(P>0.05),但B组中1例(5.3%)患者出现黄疸复发,1例(5.3%)患者出现胃输出梗阻,而A组则没有,差异有统计学意义(P<0.01)。与A组比较,C组患者术后血胆红素水平、再入院例数、黄疸复发率以及胃输出梗阻发生率更高(P<0.05和P<0.01)。C组患者的术后平均住院时间和平均生存期均短于A组(P<0.01和P<0.05)。结论对于患有不能切除的胰头癌老年患者,外科手术减黄不会增加并发症发生率,并可以提高其生存质量。

Objective To determine the safety and efficacy of surgical biliary bypass on the elderly patients with unresectable pancreatic head cancer. Methods The clinical data of 55 cases with unresectable pancreatic head cancer treated with palliation methods from July 2002 to June 2009 in our hospital were retrospectively analyzed. The patients were divided into three groups according to different age and therapeutic program：Nineteen patients,65 years of age or older,were managed with surgical biliary bypass （group A）,19 patients under 65 years of age were treated by surgical biliary bypass （group B） and 17 patients with the age of 65 years or older received percutaneous transhepatic biliary drainage （group C）. Then the therapeutic results were compared. Results With respect to the postoperative level of serum bilirubin,the incidence of early complications,postoperative hospitalization and mean survival time,no statistically significant difference was found between group A and B （P0.05）. There was one case of recurrent jaundice and one case of gastric output obstruction in group B,while no one suffered postoperative complication in group A,and the difference was statistically significant （P0.01）. Compared with group A,the postoperative level of serum bilirubin,the number of patient readmitted,the rate of recurrent jaundice and gastric output obstruction were higher in group C （P0.05 or P0.01）. The mean postoperative hospitalization and overall survival time were significantly shorter in group C than group A （P0.05 or P0.01,respectively）. Conclusion Surgical palliation does not increase the morbidity rate,but it does improve the quality of life in elderly patients with unresectable pancreatic head cancer.