结肠癌侵犯十二指肠的根治性手术疗效分析

Curative effect analysis of radical surgery for colon cancer invading duodenum

目的探讨结肠癌侵犯十二指肠患者的临床病理特征，评估根治性手术的近、远期疗效。方法回顾性分析1995-2010年采用根治性手术治疗结肠癌侵犯十二指肠的19例患者的临床资料及随访情况，并进行生存分析。19例采用根治性手术治疗结肠癌侵犯十二指肠的患者中，1例行右半结肠切除＋胰十二指肠切除术，2例行右半结肠切除＋保留幽门的胰十二指肠切除术，1例行右半结肠切除＋十二指肠肠段切除＋十二指肠空肠Roux—en—Y吻合术，4例行右半结肠癌根治术，其余11例行右半结肠切除＋十二指肠肠壁局部切除修补术。结果所有患者术后未出现肠漏、胰漏等严重并发症，术后3个月内无患者死亡。患者中位生存期为5．3年，1年生存率为94．4％，5年生存率为70．4％；3例患者在术后3年内复发。结论对于结肠癌侵犯十二指肠的患者，根治性手术是安全的，可获得较高的5年生存率，能明显改善患者预后。

Objective To discuss the elinicopathological characteristics and access the immediate- and long-term outcome of radical surgery in patients with colon cancer invading duodenum. Methods A retrospective review of 19 patients with colon cancer invading duodenum underwent radical surgery between 1995 and 2010 was performed. There were 7 male and 12 female, age ranged from 36 to 73 years with an average of 56 years. The main manifestations were abdominal pain, loss of weight, change of stool frequency and so on. The tumors located at the hepatic flexure in 15 patients. All of the patients underwent radical surgery, and none of the patients had positive resection margins. One patient underwent panereaticoduodenectomy combined with right hemieoleetomy （RH）. Two patients underwent pylorus preserving pancreaticoduodenectomy combined with RH. One patient underwent duodeneetomy combined with RH. Four patients underwent RH. And the other 11 patients underwent lateral duodectomy combined with RH. Results There was no postoperative morbidity and mortality, and the 30-day mortality rate was 0. The median overall survival was 5.3 years. Overall 1 and 5 years survival rate were 94.4% and 70. 4% , respectively. And 3 patients developed recurrence in 3 years. Conclusions The patients with colon cancer invading duodenum are lack of specific clinical manifestations. And the radical surgical procedure is safe, which could prolong the survival and improves the prognosis in these patients.