胰腺癌的外科治疗及随访研究(附216例报道)

目的 探讨胰腺癌的治疗方法对其生存时间及生存率的影响，总结胰腺癌的治疗经验。方法 回顾分析我院1990年1月至2000年12月收治的216例胰腺癌病人资料（部分），并进行了随访研究。应用SPSS10．0统计软件包进行统计学分析，生存分析采用乘积极限法（Kaplan-Meier method)，并进行时序检验（log-rank test)。结果 本组手术切除率为40．24％（68／169），根治性切除率31．36％（53／169），切除组院内死亡率为2．37％（4／169）。根治性切除组，姑息性切除组，姑息性旁路引流组，单纯手术探查组，未手术组的中位生存期分别为30 4d,138d,134d,123d,86d。根治性切除组的1，3，5年生存率分别为44．71％，14．98％，9．99％。I，Ⅱ期病人根治性切除术后1，3和5年生存率分别为69．23％，38．46％，12．82％。1995年以来，我们对胰腺癌尤其是胰头癌采用较为系统和规范的评估与探查方案，手术切除率和生存率明显改善，手术切除率上升到50．88％，根治性切除率达38．60％，根治性切除组的5年生存率达12．93％。结论 根治性切除仍是目前唯一有效的治疗方法；姑息性治疗不能延长胰腺癌病人生命；胰腺癌进行单一外科治疗的效果不容乐观，应寻求一种更为有效的治疗模式。

Surgical treatment of pancreatic cancer: a follow-up study in 216 cases

Objective To investigate the effects of various treatments for pancreatic cancer on survival of patients and summarize the experience in treatment of the disease. Methods The clinical data of 216 patients with pancreatic cancer treated in our hospital between 1990 and 2000 were retrospectively analyzed. All the patients were followed up. SPSS10 0 software package was used for statistical analysis. Meanwhile, Kaplan Meier method and log rank test were used. Results In 169 patients who had been operated on, the surgical resection rate was 40 24% and radical resection rate 31 36%. The median survival time in patients undergoing radical resection, palliative surgical resection, bypass, surgical exploration and none of operations was 304, 138, 134, 123 and 86 d, respectively. The 1 , 3 and 50 year survival rates in patients receiving radical resection were 44 71%, 14 98% and 9 99%, respectively. The 1 , 3 and 5 year survival rates in patients with pancreatic cancer of stage I and II after radical resection were 69 23%, 38 46% and 12 82%, respectively. We have adopted the method of systemic evaluation and standard surgical exploration since 1995. As a result, the surgical resection rate was up to 50 88%, radical resection rate to 38 60% and the 5 year survival rate in patients receiving radical resection to 12 93%. Conclusions Only radical resection is an effective method and palliative treatment can not prolong the lives of patients. The single surgical treatment for pancreatic cancer is dismal and a more effective treatment model should be established.