胰头癌扩大根治术的临床意义

Significance of extended radical resection for cancer of pancreatic head

目的 探讨扩大根治术对胰头癌的治疗意义及其适应证。方法 回顾分析了 1995～1998年期间我科收治的 5 6例胰头癌患者的临床资料 ,其中 2 1例接受扩大根治术 ,同期 35例接受胰十二指肠切除术。利用 1,2 ,3年累积生存率和死亡率评估两种术式的疗效。借助于CT回顾性评估临床分期以探讨扩大根治术的适应证。结果 扩大根治术的 1,2 ,3年累积生存率分别为 84 .8%、6 2 .8%和 39.9% ;胰十二指肠切除术的 1,2 ,3年累积生存率分别为 70 .8%、4 7.8%和 17.2 % ,差异有显著性。两组术后 3年累积死亡率分别为 5 1.4 %和 4 2 .9% ,差异有显著性 ,局部复发累积死亡率由胰十二指肠切除术的 37.4 %下降到扩大根治术的 2 3.8%。胰十二指肠切除术组只有临床 1期才能生存3年以上 ,而扩大根治术组临床 1,2期和部分 3期患者可存活 3年以上。结论 扩大根治术能够通过降低局部复发率而提高胰头癌患者的生存率 ,扩大根治术的适应证是临床 1,2期和部分无严重胰外侵犯的 3期患者 ,而不适于严重胰外侵犯的 4期患者。

ObjectiveTo evaluate the significance of extended radical resection in the treatment of pancreatic head cancer and its indication. MethodsBetween Jan. 1995 and Dec. 1998, 56 patients with pancreatic head cancer were retrospectively reviewed, among whom 35 were treated by the Whipple operation and 21 received the extended radical resection during the same interval. ResultsThere was no significant difference between the mortality and morbidity rate of complication, though with more patients having higher clinical stages in the extended radical resection group. The 1-, 2- and 3-year survival rates were 84.8%, 62.8%, 39.9% in the extended radical resection group and 70.8%, 47.6%, 17.2% in the Whipple operation group with significant difference between the two groups. The total mortality rate was 51.4% in Whipple group and 42.9% in extended radical resection group with significant difference between the two. The 3-year cumulative rate of death from local recurrence decreased from 37.4% in the Whipple group to 23.8% in the extended radical operation group. Patients who survived for more than 3 years were only those in clinical stage (SC)1 in the Whipple group whereas they were found both in patients who had had CS1, CS2 lesions and also in some who had CS3 lesions in the extended radical resection group. ConclusionThe extended radical operation does benefit patients with pancreatic head carcinoma in CS1, CS2 and in a part of CS3 without too extensive exrtra-pancreatic invasion.