壶腹及壶腹周围癌51例治疗分析

目的 探讨壶腹及壶腹周围癌的手术治疗措施。方法 对３２例壶腹及壶腹周围癌患者行Ｗｈｉｐｐｌｅ手术。３２例中术前因胆道梗阻合并感染行胆囊造瘘引流１０例;术中胆囊造瘘引流１６例,Ｔ管引流４例。多孔硅胶管插入胰管５ｃｍ支撑,另一端置空肠引流３２例。与同期内未行手术治疗者１９例对比。结果 术后胆瘘１例,胰瘘１例,无手术死亡者,全组平均随访５年,１、３、５年生存者分别为３１例、１７例、１１例,５年生存率为３     

胰十二指肠切除术治疗壶腹周围癌19例体会

胰十二指肠切除术治疗壶腹周围癌１９例体会张少宏，全主见，向军章，向才来，朱为尧，钱秋炳我们自１９７８～１９９５年共收治壶腹部周围癌４０例，其中通过近年来改进探查切除的方法和应用新的胰空肠吻合技术与血管外科技术治疗１９例，提高了切除率，减少了胰瘘等并发...     

局部切除术治疗Vater壶腹癌四例

胰十二指肠切除术仍是目前治疗Ｖａｔｅｒ壶腹癌的最佳术式 ,但因肝功差 ,凝血机能不良 ,手术难度大 ,并发症及手术死亡率高 ,不适于高龄、一般情况差、有严重合并症等高危因素的患者。近年来又兴起的壶腹癌局部切除术为这些患者提供了切除肿瘤 ,延长生存期 ,改善生命质量甚至达到治愈的目的。我院自 1993年以来应用此术治疗壶腹癌 4例 ,取得一定效果 ,现报告如下。一、临床资料本组 4例 ,男 2例 ,女 2例 ,年龄 5 5～ 77岁 (6 6岁以上 3例 )。 4例均因进行性黄疸入院 ,1例伴上腹疼痛 ,余 3例为无痛性黄疸 ,均有不同程度的消瘦、乏力、食欲差…     

壶腹癌局部切除术的体会

手术治疗是唯一能治愈壶腹癌的有效方法,但是如何选择手术方式是一个值得商榷的问题。我们在１９９０年３月～１９９８年１２月间根据病人的不同情况,对２１例壶腹癌分别采用了胰十二指肠切除术１１例,壶腹肿瘤局部切除６例,总胆管十二指肠侧侧吻合术４例。取得了较好的疗效。现就本组资料并对局部切除手术加以讨论。１　临床资料１．１　一般资料本组共２１例,男１２例,女９例,最大年龄７１岁,最小４４岁,平均６２．１岁。都有梗阻性黄疸,病程１周到３个月,平均３．１周。其中２例合并慢性肺气肿,两例合并有陈旧性前间壁心肌梗…     

壶腹周围癌胰十二指肠切除术预后因素

胆总管下端、壶腹、十二指肠乳头及胰头的恶性肿瘤因为临床表现相似,临床上统称壶腹周围癌。壶腹周围癌的早期诊断和治疗方面一直存在困难,唯一可能治愈的方法是手术切除,如胰十二指肠切除术（pancreaticoduodenectomy,PD）。肿瘤根治术后整体长期存活率是外科医牛所共同关注的问题。就PD术预后而言,壶蝮部癌及十二指肠乳头部癌最高,远端胆管癌次之,胰头癌最差。对于壶腹周旧癌行PD术后存活率的相关因素,得到公认的包括肿瘤病理来源、细胞分化程度、TNM分期等。而近年国内外在该方而又有了深入研究,现就壶腹周围癌PD术后预后相关因素的研究进展综述如下。     

壶腹周围癌区域性胰腺切除术后近期并发症及处理

目的总结壶腹周围癌区域性胰腺切除术术后近期并发症,探讨其防治策略.方法分析比较1997年12月～2004年7月胰腺肿瘤外科专业小组建立前后325例壶腹周围癌区域性胰腺切除术术后近期并发症的发生情况,总结术中术后的处理方法.结果1997年12月～2001年12月109例病例,2002年1月～2004年7月216例病例.前后两阶段术后近期发生总并发症例数分别为21例（19.3%）和18例（8.3%）,总死亡例数分别为4例（3.7%）和0例（0.0%）.前后两阶段术后近期胆胰瘘的发生率分别为8.3%和3.2%;腹腔内大出血的发生率分别为3.7%和0.0%,差异均有统计学意义（P＜0.05）.结论科学的手术可行性评估、胰腺肿瘤外科专业手术小组的建立、合理的围手术期处理是降低区域性胰腺切除术术后并发症发生率和死亡率的关键.     

壶腹周围癌的诊断与治疗

本文报告壶腹周围癌１６８例，行胰十二指肠切除术６２例，全胰切除术互例，总切除率为３７．５％，切除率最高者为Ｖａｔｅｒ氏壶腹癌和十二指肠降部癌，分别为８８．０％和８５．０％，而胰头癌切除率仅为１４．９％。术后发生并发症２０例，占１１．９％。手术死亡９例，死亡率为为５．４％。全部获得随诊，切除组３年和５年生存率分别为３２．１％和１２．４％。未切除组均行胆肠内引流术，平均生存时间为５．２月。强调提高壶腹周围癌治疗水平的关键在于早期诊断与早期手术。     

57例壶腹周围癌治疗体会

壶腹周围癌包括胰头、乏特壶腹、十二指肠降部、胆总管下段的恶性肿瘤。现将1993—2002年诊治的57例壶腹周围癌分析如下。     

小壶腹周围癌的局部切除

目的　介绍一种小壶腹周围癌的有效、安全、简便的局部切除方法。方法　切开胆总管中段 ,向远端插入导尿管 ,以了解肿瘤侵犯胆总管末端的程度。切开十二指肠前壁 ,距肿瘤 2cm处电刀环形切除 ,边切边缝合十二指肠和胆总管粘膜。将胃肠减压管下拉到十二指肠降部 ,鼻饲营养管末端置于空肠中。结果　 1 2例手术后病理报告切缘均无癌残留 ,无术后并发症 ,痊愈。 7例随诊1 2～ 57个月 ,均健在。住院时间及诊疗费用仅为whipple手术的 50 %左右。 结论　对于小于 2cm的壶腹周围癌 ,尤其是高龄或有并发症的患者 ,该术式是一种安全、有效的治疗方法。     

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目的 评价经肛门局部切除治疗低位直助癌的效果。方法 回顾性分析1991—2000年间经肛门局部切除治疗24例低位直肠癌的临床资料。结果 (1)24例均为直肠腺癌。(2)24例直肠癌T0期2例，T1期8例，T2期14例。(3)围手术期病死率为0。(4)术后特异性并发症仅有1例，占4．2％。(5)有4例局部复发。其中1例经局部切除治愈；另外3例行经腹会阴联合切除术，其中1例于术后3．5年固多发转移死亡。(6)本组直肠癌病人经肛门局部切除术后，随访均超过2年，5年生存率为93．10％。结论 低位直肠癌采用经肛门局部切除手术结合放疗的方法可以达到很好的疗效且并发症少，但应严格掌握适应证，慎重选择病例。     

Local excision of rectal carcinoma not-exceeding the muscularis layer

Aim The aim of the study was to compare the results of treatment by local excision of two different clinical stages of the rectal cancer. Material and methods Fifty‐eight patients with early rectal carcinoma were operated on during the last 26 years using different methods of local exscision. The carcinomas were initially assessed as not‐exceeding the muscularis layer of the rectal wall. The tumours, localized up to 12 cm from the anal margin, were removed by means of ‘parachute’ excision (47 patients). In 6 patients, carcinoma localized in the central part of rectum, was excised by means of the Localio method. Transanal endoscopic microsurgery was applied in 5 cases of carcinoma localized on the depth of 5–20 cm from the anal margin. Results After local excision the patients were divided into two groups: I, tumours of low degree of malignancy, not exceeding submucosal layer (26 patients); II, tumours of low or median degree of malignancy with infiltration of muscularis layer (32 patients). There was a significant difference in cancer relapses between groups I and II. One patient in group I and 9 in group II developed local recurrences (P < 0.05) and 5 patients in group II had neoplastic dissemination (15.6%). Conclusions Best results were obtained in patients with carcinoma not exceeding submucosal membrane. In cases of rectal muscular layer infiltrations, the risk of carcinoma relapses was markedly higher. The use of transanal endoscopic microsurgery has permited removal of tumours from the upper rectum.     

经肛门局部切除术治疗Ⅰ期低位直肠癌

目的 探讨Ⅰ期低位直肠癌局部切除术临床应用的合理性.方法 回顾性分析93例Ⅰ期(T1-2N0M0)低位直肠癌患者的资料.按手术方式不同分为:局部切除术组(45例)和根治术组(48例).局部切除术组均行经肛门局部切除术,术后T1期(24例)行辅助放疗,T2期(21例)行辅助放、化疗.根治术组(T1期18例,T2期30例)均行根治术(行腹会阴联合切除术42例,低位前切除术6例),术后未行放、化疗.所有患者均随访5年以上.对两组患者的生存率、复发率、并发症发生率进行比较分析.结果 (1)局部切除术组和根治术组5年生存率T1期均为100%(24/24,18/18),T2期分别为86%(18/21)和93%(28/30),两组比较差异无统计学意义(P＞0.05).(2)局部切除术组和根治术组5年复发率T1期分别为4%(1/24)和0(0/18),T2期分别为19%(4/21)和7%(2/30),两组比较差异无统计学意义(P＞0.05).(3)局部切除术组并发症发生率为2%(1/45),根治术组为15%(7/48),前者显著低于后者(P＜0.05).结论 对于Ⅰ期低位直肠癌,经肛门局部切除术联合术后放、化疗可获得与根治术相近的5年生存率,是一种合理的治疗方式.     

Presentation and prognosis of local recurrence after total mesorectal excision

Objective  The aim of this study was to describe the presentation, treatment and prognosis of local recurrences following total mesorectal excision for rectal adenocarcinoma.
Method  Between 1999 and 2002, 201 patients were treated with total mesorectal excision for mid or low rectal cancer and were followed up prospectively.
Results  Overall 2-year survival was 85%. The 2-year recurrence rate was 8%. Eighteen patients developed local recurrence at 3–60 months.
Nine recurrences originated from the pelvic sidewall. These recurrences were symptomatic in 90% of patients. Only two patients were reoperated with a R0 resection and were alive without local recurrence after 19 and 31 months. The seven others died within 9 months.
Nine recurrences originated from an anastomotic suture line. Only two had symptoms. A R0 surgical resection was performed in all patients with a 67% sphincter conservation rate. After 26-months of median follow-up (range 7–58), all patients were alive.
Conclusion  Half of the local recurrence after total mesorectal excision was located at the anastomotic site. Rectoscopic examination should be performed regularly to detect these anatomotic recurrences that are accessible to a R0 itérative resection.     

局部切除术治疗Vater壶腹部肿瘤临床体会

目的评价局部切除术治疗Vater壶腹部肿瘤的效果：方法对1995年1月～2006年10月行局部切除治疗的19例Vater壶腹部肿瘤患者进行回顾性分析-结果全部病例无手术及住院死亡,术后并发症发生率为158％（3／19）3例良性肿瘤已分别存活3年、6年和8年。16例恶性肿瘤中,1年生存率为87．5％（14／16）;3年和5年生存率现已达50．0％（8／16）,25％（4／16）,其治疗效果满意。结论局部切除手术符合胆汁引流的生理状态,创伤相对小,恢复快,手术合并症及病死率也较低,因早期较小的肿瘤以及良性肿瘤局部恶变而肿瘤被完整切除．患者得到较长生存时间或得以治愈．     

Body image score following anterior and lateral approaches to wide local excision for early breast cancer

Breast cancer surgery is an emotive topic and rather than just simple cosmetic issues, the final appearance of the operated breast has been shown to have a significant impact on psychologic well-being and overall quality of life. Wide local excision (WLE) is a popular conservative approach to small tumors, which do not involve the nipple-areolar complex. This study compares WLE via an anterior and lateral approach. A retrospective survey of patient satisfaction was performed using a recognized and validated Body Image Score (BIS), which was sent to a total of 267 patients who had undergone WLE by either the anterior or lateral approach. The response rate was 57%, of which 89 women had undergone surgery via the anterior and 80 by the lateral approach. There was no significant difference in BIS when comparing the anterior and lateral approaches, despite concerns regarding the physical appearance of the scar and postoperative breast expressed by patients. Generally, surgery on the upper part of the breast was associated with less satisfaction than the lower, but "hiding" the scar with a lateral approach did not improve satisfaction. Surgeons should be reassured that the approach to WLE of early breast cancers has no impact on the patients overall body image and that the choice of technique should be based on the patient's personal preference and the surgeons experience and skill.