再次剖腹手术行壶腹部癌根治性切除(附7例报告)

Reoperative radical resection for periampullary carcinoma:a report of 7 cases.

目的 探讨 7例再次剖腹手术行壶腹部癌根治性切除的病人在第一次手术时未行根治性切除的原因。方法 结合术后随访 ,详细回顾病例资料。结果 第一次剖腹手术时认为癌肿不能切除 3例 ,漏诊 3例 ,误诊 1例 ;第二次手术前结合内镜逆行胰胆管造影 (ERCP)、CT等检查 ,均明确诊断为壶腹部癌 ,其中CT显示壶腹部占位 5例 ,均未见胰外转移及血管侵犯。均再次剖腹施行胰十二指肠切除术。结论 胆道远端恶性梗阻病人术前ERCP、CT等影像学诊断极为重要 ,有助于明确诊断 ,减少手术盲目性 ,避免再次手术。

Objective To explore why pancreaticoduodenectomy was not performed at the initial operation in 7 patients with periampullary carcinoma who underwent a reoperative PD.Methods From Jan 1990 to Dec 1999,7 patients were referred to our hospital for periampullary carcinoma following an exploratory laparotomy on whom PD was not performed,the clinical data were reviewed.Results PD was not performed at the first laparotomy because of the surgeon's assessment of unresectability(3 patients),the lack of diagnosis of malignancy(3 patients) and misdiagnosis(1 patient).All 7 patients were diagnosed as periampullary carcinoma prior to reoperation with CT and ERCP,et al,and underwent a successful PD.The average survival was 26 months,and 2 patients have remained alive more than 5 years after surgery.Conclusion Detailed preoperative imaging examinations can reduce intraoperative uncertainty,and avoid reoperation for patients with obstruction of distal common bile duct.