保留幽门的胰十二指肠切除术治疗壶腹周围癌临床探讨

Results of Pancreaticoduodenectomy with pylorus-preservation in pancreatic and periampullary carcinomas

目的 总结采用留幽门的胰十二指肠切除术 (PPPD)治疗的壶腹周围癌患者的生存情况 ,探讨PP PD的手术彻底性。 方法 将47例PPPD与同期127例经典的胰十二指肠切除术 (PD)作对照研究 ,分析两组患者的术后生存率。 结果 PPPD组与PD组术后并发症发生率分别为34.0 %和27.6% ,差别无显著性意义 (P>0.05) ;中位生存时间分别为31个月和29个月 ;两组生存率曲线比较差别无显著性意义 (P>0.05) ;术后5年生存率分别为38.1%和31.0% ,差别无显著性意义 (P>0.05) ;其中的胰头癌患者 ,5年生存率分别为15.7 %和21.2 % ,差别也无显著性意义 (P>0.05) ;同时发现 ,Ⅰ、Ⅱ期肿瘤患者的5年生存率为46.5% ,而Ⅲ、Ⅳ期肿瘤患者的5年生存率仅为4.6% ,两者差别有显著性意义 (P<0.01)。结论

Objectives To evaluate the results of pylorus-preserving pancreaticoduodenectomy(PPPD) in the treatment of selected patient with carcinoma of the pancreatic head or the periampullary region.Methods From Dec 1984 to Dec 1999,174 patients with carcinoma of the pancreatic head or with periampullary cancer underwent either PPPD(n=47) or standard pancreaticoduodenectomy(PD,n=127),the short- and long-term results with PPPD and with PD were compared.Results The overall rates of hospital morbidity were 34.0% in PPPD group and 27.6% in PD group,respectively.There were no differences in actuarial survival curves between PPPD and PD(P>0.05).The median survival time was 31 and 29 months,5-year survival rates 38.1% and 31.0%,respectively without significant differences(P>0.05).But for patients with tumor in stages Ⅲ and Ⅳ the 5-year survival rate was significantly lower than those in stages Ⅰ and Ⅱ(P<0.01).Conclusion PPPD is an acceptable alternative to the PD in the treatment of cancer of the pancreatic head or the periampullary region if the proximal duodenum or peripyloric lymph nodes are not infiltrated by the tumor.