摘要
目的 探讨老年患者胰腺癌接受胰十二指肠切除术，以期明确手术成功的相关因素。方法 本研究包括74例大胰癌患者。35例年龄大于70岁，30例为标准胰十二指肠切除术和5例为区域性胰十二指肠切除术，其中15例按“三步法”予以切除。这组患者的结果与另外39例非老年患者作比较。结果 老年患者的30天手术死亡率与并发症率分别为5．9％和26．4％；而在非老年患者中分别为5．2％和18．4％。危险因素、并发症率和死亡率差别有统计学意义。老年患者和非老年患者的5年生存率分别为11．7％和15．7％，无显著性差异。结论 本研究表明老年患者可安全接受根治性胰十二指肠切除术，而长期效果与非老年患者相似。减黄可改善肝、肾功能，增加患者对手术的耐受。术前介入化疗可在肿瘤与门静脉间产生“炎性水帘”，从而减少门静脉切除率。Objective To elucidate contributing factors that lead to successful management of large pancreatic cancer in geriatric patients.Methods The study involved 74 patients with larger pancreatic malignancy. Risks and benefits of pancreaticoduodenectomy at an advanced age were analyzed retrospectively in 35 patients older than 70 years of age. Of them, 15 elderly patients were radically resected by "3 steps procedure". Conventional and regional pancreaticoduodenectomy was performed in 30 and 5 patients, respec-tively. The results achieved in these patients were compared with those observed in 39 younger patients.Results The 30-day morality and morbidity rates for the elderly patients with large pancreatic cancer were 5.9% and 26.4% respectively; while for the younger patients, they were 5.2% and 18.4% respectively. A statistically significant correlation was observed between the presence of risk factors, the occurrence of complications, and the mortality rate. No difference was found between the two age groups when the risk factors were absent. The 5-year survival rate in the elderly patients and the younger patients was 11.7% and 15.7% respectively, with the difference being not significant.Conclusion Curative pancreaticoduedenectomy can be carried out safely in older patients, with long-term results comparable tothose achieved in the younger patients. The preoperative interventional chemotherapy can provide an inflammatory edema wall between the tumor and portal vein, so as to decrease the portal vein resection rates.
