胆肠吻合加胃肠吻合术治疗老年壶腹周围癌的疗效及患者耐受性观察

Clinical efficacy of biliary-intestinal and gastrointestinal anastomosis in the treatment of elderly periampuilary carcinoma and the tolerance of patients

目的胆肠吻合加胃肠吻合术（姑息性旁路手术）治疗老年壶腹周围癌的疗效及患者耐受性观察。方法选取本院2010年1月至2011年1月64例老年壶腹周围癌患者为研究对象，将患者抽签随机分为观察组与对照组，每组32例。观察组给予姑息性旁路手术治疗，对照组给予根治性手术治疗，比较两组患者术中出血量、手术时间、住院时间、减黄效果、术后情况及并发症发生率。结果观察组术中出血量少于对照组[（136．42±89．43）mlvs．（279．62±124．65）ml]，手术时间短于对照组[（219．93±67．82）minvs．（347．61±83．60）min]、住院时间短于对照组[（16．86±7．16）dvs．（27．47±11．36）d]，两组比较差异有统计学意义（P〈0．05）。观察组减黄效果有效率高于对照组（93．75％VS．71．88％），两组比较差异有统计学意义（P〈0．05）。观察组复发率、术后出血率及腹腔感染、伤口感染发生率低于对照组（P〈0．05）。观察组并发症发生率低于对照组（15．63％VS．46．88％），两组比较差异有统计学意义（P〈0．05）。结论姑息性旁路手术治疗老年壶腹周围癌的疗效显著，手术时间短，出血量少，可促进患者更快康复，降低术后复发率、出血率及感染发生率，并发症较少，患者耐受性高，可在临床推广使用。

Objective To investigate the clinical efficacy ofbiliary-intestinal and gastrointestinal anastomosis （palliative bypass surgery） in the treatment of elderly periampullary carcinoma and the tolerance of patients. Methods 64 elderly patients with periampullary carcinoma in our hospital from January 2010 to January 2011 were selected as the research object, and randomly divided into observation group and control group with the draw, 32 cases in each group. Observation group was treated with palliative bypass surgery, while control group was treated with radical surgery. The amount of bleeding, operation time, the length of stay, the effect of reducing jaundice, postoperative condition, the incidence of postoperative complications were compared between two groups. Results The intraoperative bleeding volume in observation group was less than that in control group [（136.42＋89.43）ml vs.（279.62±124.65）ml], operation time in observation group was shorter than that in control group [（219.93±67.82） min vs.（347.61±83.60）min], the length of stay in observation group was shorter than that in control group [（16.86±7.16）d vs.（27.47±11.36）d], with statistically significant differences between two groups （P〈0.05）. The effective rate of reducing jaundice in observation group was higher than that in control group （93.75% vs.71.88%）, with statistically significant difference between two groups （P〈0.05）. The recurrence rate, the incidences of postoperative bleeding, abdominal infection, wound infection in observation group were lower than those in control group （P〈0.05）. The incidence of complications in observation group was lower than that in control group 05.63% vs.46.88%）, with statistically significant difference between two groups （P〈0.05）. Conclusion Palliative bypass surgery has significant clinical efficacy in the treatment of elderly periampuUary carcinoma, with short operation time, less bleeding volume, less complications, high tolerance of patients, which can promote patients recover more quickly, reduce postoperative recurrence rate, bleeding rate, and the incidence of infection, can be used in clinical practice.