贲门癌保留胰腺手术的适应证及疗效探讨

Discussion on Indication and Curative Effects of Operations with Preservation of Pancreas for Carcinomas of Cardia

目的:评价保留胰腺在贲门癌D2手术中的适应证及近、远期疗效。方法:将同期手术的Ⅱ期及原发灶无胰腺侵犯的Ⅲ期贲门癌分为两组:保留胰腺手术组(保胰组),胰脾联合切除组(切胰组);从术后近期效果、11组(脾动脉干)淋巴结清扫、生存率三方面,对保胰组120例与切胰组43例贲门癌D2手术治疗结果,进行对比分析,探讨保留胰腺手术的临床应用价值。结果:保胰组手术近期效果优于切胰组,前者术后并发症发生率低于后者(P<0.01)。两组行11组淋巴结清扫的疗效相近;两组的D2术后3、5年生存率无显著差异(P>0.05)。结论:贲门癌D2术保留胰腺手术适应证为Ⅱ期、原发灶无胰腺侵犯的Ⅲ期病例、11组淋巴结肿大但未与胰腺实质浸润者;保留胰腺手术并发症低,近期效果好,如将11组淋巴结彻底切除,可获得较好的远期疗效。

Objective:To evaluate indication,long and short-term effects of preservation of pancreas in D 2 gastrectomy for carcinomas of cardia.Methods:Carcinomas of cardia in stageⅡand stageⅢwithout infiltrating pancreas,which were undergone D 2 gastrectomy in the same peri-od,were divided into two groups:preserved pancreas group and pancreatectomy group;From post-operative short-term effect,№11(splenic artery)lymphectomy and survival standpoints,outcome of surgical treatment was analyzed comparatively between120cases in preserved pancreas group and43cases in pancreatectomy and discuss clinical application value of preservation of pancreas.Re -sults:(1)Short-term effect in preserved group was better than that in pancreatectomy group and postoperative complications were lower than latter(P<0.01).(2)The effects of№11lymphectomy in both groups were similar.(3)There was no survival difference between two groups (P>0.05).Conclusion:Indication of preservation of pancreas in D 2 gastrectomy of carcinomas of cardia was:those cases that was in stageⅡand stageⅢwithout involving pancreas,moreover,№11lymph nodes didn't infiltrate pancreas.Operation with preservation of pancreas had clinical application value because of fewer complications,better short-term effect,and long-term effect could be ob-tained if№11lymph nodes could be resected completely.