胰腺癌保留幽门胰十二指肠切除术式探讨

Pancreaticoduodenectomy for pancreatic head cancer:PPPD versus SPD procedures

目的探讨保留幽门胰十二指肠切除术(PPPD)与标准胰十二指肠切除(SPD)治疗胰头癌术后并发症和术后恢复情况及对预后的影响。方法回顾性分析2004年1月至2008年4月34例PPPD与同期127例SPD治疗胰头癌的围手术期并发症发生情况及预后情况。结果 SPD组围手术期死亡4例(3.15%),PPPD组围手术期死亡1例(2.94%)。SPD组平均手术时间195(75～415)min,术中平均失血320(70～2450)ml,PPPD组手术时间184(90～315)min,术中平均失血295(100～2230)ml,两组比较差异无统计学意义。术后发生胃排空延迟(DGE)PPPD组9例(26.5%),SPD组5例(3.9%)(P<0.001)。SPD组和PPPD组在中位生存时间和术后生存率上差异无统计学意义。结论标准SPD手术和PPPD在手术时间、失血量、围手术期病死率及术后生存率上差异无统计学意义。但PPPD术后发生DGE的概率较高。

Objective Resectable carcinoma of pancreatic head can be curable.This cohort study was to investigate the differences between standard pancreaticoduodenectomy（SPD） and pylorus-preserving pancreaticoduodenectomy（PPPD）.Methods From January 2004 to April 2008,a comparison was made between SPD procedure and PPPD for patients with carcinoma of the head of the pancreas.Among 161 patients,127 received SPD,and 34 underwent PPPD.Results Four perioperative deaths occurred in the SPD group and 1 perioperative death in the PPPD group.The median duration of SPD was 195 minutes（ranging from 75 to 415 minutes） with a median blood loss of 320 ml（70-2450 ml）.In the PPPD group,median operating time was 184 minutes（ranging from 90 to 315 minutes）,and the median blood loss was 295 ml（ranging from 100 to 2230 ml）.These data were not significantly different.Delayed gastric emptying was observed more frequently after PPPD（9 of the 34 patients） than after SPD（5 of the 127 patients）（P0.001）.There was no significant difference between SPD and PPPD in terms of median survival and 5-year survival rate.Conclusions There was no significant difference between SPD and PPPD for the treatment of pancreatic head cancer in terms of operating time,blood loss,operative mortality and long-term survival.However delayed gastric emptying was encountered more frequently in the PPPD group than in the SPD group.