胰腺癌427例外科手术疗效分析

Analysis of the curative effect of 427 cases of pancreatic cancer

目的分析427例胰腺癌患者外科手术治疗的临床效果。方法选取胰腺癌患者427例作为研究对象。按治疗方式分为三组：根治性切除手术组（包括胰十二指肠切除术组及胰体尾联合脾脏切除组，268例），姑息性手术组（122例），未行手术组（37例）。术后评估手术组的并发症发生率及手术死亡率，严密随访3年，比较三组生存率，绘制生存率曲线图；测量三组患者治疗后的生存质量评分，比较各组评分差异，评价手术治疗的临床效果。结果根治性切除术组术后并发症发生率明显高于姑息性手术组，差异有统计学意义（P〈0.05）；两组手术组病死率分别为3.35%（9/268）、1.60%（2/122），组间比较差异未见统计学意义（P〉0.05）。生存率比较，根治性切除术组显著高于其他两组，差异有统计学意义（P〈0.01），其1、2、3年生存率分别为52.94%、31.33%、11.74%，明显高于姑息性手术组及未行手术组，差异有统计学意义（P〈0.05）；而姑息手术组与未手术组比较，差异未见统计学意义（P〉0.05）。生存质量测评结果表明，手术组分值高于未行手术组，差异有统计学意义（P〈0.05），根治性切除术组分值高于姑息性手术组，差异有统计学意义（P〈0.05）。结论胰腺癌施行根治切除（包括胰十二指肠切除及胰体尾联合脾脏切除术）能显著提高治疗效果及改善预后，提高远期生存率，同时能明显提高患者的生存质量。对不能根治切除的患者，应争取行姑息性手术，也可提高生存率及改善生存质量。

Objective To analyze the clinical effects of surgical treatment on 427 cases of pan- creatic cancer. Methods A total of 427 patients with pancreatic cancer were selected. According to treatment patterns, the 427 cases of pancreatic cancer were divided into three groups： radical surgery group （including pancreatoduodenectomy and pancreatoduodenectomy combined with splenectomy, n = 268 ） ;palliative operation （n = 122） and no surgery group （n = 37 ）. The postoperative complication rate and operative mortality were evaluated in the operative group. The follow-up period was 3 years. The sur- vival rates of the three groups were compared, and the survival rate charts were drawn. The quality of life scores of the three groups were measured, and the difference of the scores between the two groups was compared, and the clinical effects of surgical treatment was evaluated. Results The complication rate was, significantly higher in radical surgery group than that in palliative group （P 〈 0. 05 ）. The operative mortality in the radical surgery group and palliative group was 3.35% （9/268） and 1.60% （2/122） re- spectively, there was no significant difference between （ P 〉 0. 05 ）. The survival rate in the radical re- section group was significantly higher than that in the other two groups, and the differences were signifi- cant （P 〈0. 01）. However, the survival rate had no significant difference between palliative group and no surgery group （P 〉 0. 05 ）. The survival rates of 1, 2, 3-year in radical surgery group were 52. 94% , 31.33%, 11.74%, respectively, which were higher than those in palliative group and no surgery group. There was no significant difference between the palliative group and the no operative group in the 1, 2,3-year survival rates （P 〉 0. 05 ）. The quality of life assessment showed that the score of operation group was higher than that of no operative group, the difference was significant （P 〈 0.05 ）, and the score of radical resection group was higher than that of palliative operation group, the difference was significant （P 〈 0. 05）. Conclusions Radical resection of pancreatic cancer （ including pancreaticoduodenectomy and pancreatic body tail combined with splenectomy） can significantly improve the treatment effect and improve prognosis, improve the long-term survival rate, and significantly improve the quality of life of pa- tients. For the patients who can not be excised radical excision, palliative surgery should be strived, in order to improve the survival rate and improve the quality of life.