可能切除性胰腺体尾部癌的外科手术治疗研究

Clinical research of operation in the treatment for potentially resectable cancer of pancreatic body-tail

目的探讨可能切除性胰腺体尾部癌行外科手术治疗的技术方法及临床疗效。方法 11例伴有局部侵犯的可能切除性胰腺体尾部癌患者,均以逆行切除方式施行根治性切除手术,同时辅以术后化疗并追踪随访。结果 11例患者中10例达到R0切除,1例为R1切除。3例切除了受累的腹腔干血管(CA)及肝总动脉(CHA),其中2例联合了全胃切除、空肠代胃术,1例因切口感染延长了住院时间外,其余病例均无严重并发症发生。术后除2例患者未能坚持规律化疗外,其余患者均行吉西他滨规律化疗。术后全部患者腹痛症状消失,中位生存时间28(14,36)个月,术后1年、3年生存率分别为90.9%、36.3%。结论可能切除性胰腺体尾部癌患者手术切除率低并长期被腹痛困扰,以逆行切除手术方式,必要时扩大手术切除范围的方法并辅助术后化疗可以一定程度延长患者的生存时间并显著改善患者的生活质量。

Objective To discuss the clinical effect and technical method of the surgical treatment for potentially resectable cancer of pancreatic body-tail.Methods Eleven patients with potentially resectable cancer of pancreatic bodytail or adjacent organ metastasis,who underwent wide excision and postoperative chemotherapy in our department were retrospectively analyzed.Results In eleven patients,10 patients with adjacent organ metastasis were performed involved organs resection,3 patients were given resection of the celiac axis(CA)and common hepatic artery(CHA)and 2 patients were given total gastrectomy and jejunal interposition pouch reconstruction.One patient had prolonged hospital stay due to incision infection,but no serious complications occurred in other patients.Except for 2 patients,the other patients underwent postoperative chemotherapy of gemcitabine.All of the patients achieved relief through operation.The median survival time was 28(14,36)months.One and 3-year survival rates were 90.9%and 36.3%.Conclusion The resection rate of potentially resectable carcinoma of pancreatic body and tail operation is lower,and patients have long been plagued by abdominal pain.The treatment of extensive resection operation and recessive resection and postoperative adjuvant chemotherapy can improve the quality of life and prolong the survival rate of patients.