中华普通外科学文献(电子版) ›› 2008, Vol. 02 ›› Issue (03) : 225 -227. doi: 10.3877/cma.j.issn.1674-0793.2008.03.015 × 扫一扫
所属专题： 经典病例；
争鸣与讨论
收稿日期:
出版日期:
通信作者:
Bao-an QIU†,1(), Gang BAI1, Hong-wei BAI1, Ying-Xiang YANG1, Nian-xin XIA1, Yang AN1, Qian XIA1
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Corresponding author:
邱宝安, 白钢, 白宏伟, 杨英祥, 夏念信, 安阳, 夏芊. 姑息性胰腺肿瘤切除的地位与作用：附107例应用分析[J/OL]. 中华普通外科学文献(电子版), 2008, 02(03): 225-227.
Bao-an QIU, Gang BAI, Hong-wei BAI, Ying-Xiang YANG, Nian-xin XIA, Yang AN, Qian XIA. The role of conservative resection for pancreatic head cancer: with 107 cases experiences[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2008, 02(03): 225-227.
目的
探讨中晚期胰头肿瘤手术切除方法，从而提高其切除率，同时探讨姑息性手术切除的地位及临床意义。
方法
回顾分析过去5年治疗107例胰腺癌患者的临床资料，观察胰腺CT对肿瘤分期判断的准确性，在血管浸润病例采取直接切断胰腺颈部方法提高手术切除率，局部应用缓释化疗粒子及局部放疗减少复发，同时观察姑息性切除患者预后的情况。
结果
胰腺CT对肿瘤的血管浸润判断准确性为78.5%(84/107)，107例患者总的手术切除率63.55%（68/107）例，围手术期并发症发生率17.8%(19/107)，死亡1例（肺部感染合并多脏器衰竭），切除患者的生存率0.5年，1年及2年分别为100%、79.4%(54/68)、41.2%(28/68)。而同期未能手术切除病例生存率分别为76.9%(30/39)、51.3%(20/39)、15.4%(6/39)，两组比较统计学差异明显（P＜0.01）。
结论
胰腺CT扫描对于判断血管浸润具有较高准确性，直接切断胰腺颈部的方法能显著提高胰腺肿瘤的切除率，姑息性胰腺肿瘤切除配合局部放化疗能够在一定程度上延长中晚期胰腺癌患者预后，值得进一步研究观察。
Objective
To explore the surgical technique on advanced pancreatic head cancer in order to improve the resection ratio and review the role of conservative resection for prognosis and survival time of the patients.
Methods
107 patients with pancreatic cancer in the last years were reviewed. CT scans of the pancreas were used to evaluate the stage of the pancreatic cancer especially the invasion of SMA and SMV before surgical intervention.Direct dissection of the pancreatic neck were performed during operation for vessel invasion patients in order to increase the resection ratio. Local chemotherapy and radiotherapy were routinely carried out to lower the recurrence of the tumor.The prognoses of the patients who underwent conservative resection were followed up.
Results
The overall accurate ratio of pancreatic CT scans for vessel invasion was 78.5%, retrospectively. The resection ratio of all patients was 63.55%.Complications occurred perioperatively was 17.5% and one patient died from severe lung infection accompanied with multiple organ function failure.The survival ratios of the remain patients over 6 months,1 and 2 yean were 100%,79.4%and 41.2%respectively.But the ratios of the patients with bypass operations in the same period of time were 76.9%, 51.3% and 15.4% respectively. The significant difference was found in two group though the severity might be different (P＜0.01).
Conclusion
Pancreatic CT scan is one of accurate method in the evaluation of the vessel invasion in pancreatic cancer.Direct dissection of the pancreatic neck is a effective way to increase resectablility of pancreas cancer. Conservative resection of the pancreatic cancer plus local chemo-and radiotherapy can prolong the survival time of the patients with advanced pancreas cancer and further investigation should be followed up.