改良Appleby手术治疗胰体尾恶性肿瘤的临床疗效

Clinical effect of modified Appleby operation in the treatment of carcinoma of body and tail of the pancreas

目的:探讨改良Appleby手术治疗胰体尾恶性肿瘤的手术适应证、可行性及安全性。方法:对2003年1月至2012年6月我科15例接受改良Appleby手术病人的临床资料,回顾性分析病人术中、术后恢复及并发症。结果:15例病人手术均获得成功,其中4例行肝总动脉重建,中位手术时间295(225～420)min,术中中位出血量1 000(500～2 000)mL,术后并发症发生率46.7%(7/15),为胰漏、乳糜漏、腹腔积液、感染等;6例术后出现肝功能一过性异常,经保肝治疗,2周内均恢复正常;除1例死于术后相关并发症,14例术后中位生存时间16个月;病人1年和3年生存率为86.7%和6.7%。结论:改良Appleby手术安全可靠,可以提高胰体尾恶性肿瘤的手术切除率,一定程度上延长病人生存时间,并显著提高病人术后生活质量。

Objective To explore the indications, safety and feasibility of modified Appleby operation in the treat- ment of carcinoma of pancreas located at the body and tail. Methods Fifteen patients who underwent modified Appleby operation from Jan 2003 to Jun 2012 in our department were retrospectively studied. The operative procedure and reco- very, and postoperative complications were analyzed. Results All the 15 patients were successfully operated. Four pa- tients had been performed with common hepatic artery reconstruction. The median operative time was 295 （225-420） min. The median blood loss was 1 000（500-2 000） mL. The postoperative complication rate was 46.7%（7/15）, including pancre- atic fistula, chylous fistula, abdominal effusion and infection. Abnormal liver function was present postoperative in 6 pa- tients and returned to normal within 2 weeks. One patient died at the second month after operation. The median survival time was 16 months. One and 3-year survival rates were 86.7% and 6.7%, respectively. Conclusions Modified Appleby operation is feasible and safe for carcinoma of body and tail of the pancreas. It can prolong the survival time and improve life quality of the patients.