胰十二指肠切除术治疗壶腹部癌和胰头癌临床分析

壶腹周围癌是指胆胰壶腹周围2cm范围内的恶性肿瘤，包括壶腹部癌（胆总管末端壶腹癌和十二指肠乳头癌）、胰头癌及十二指肠降段的恶性肿瘤．胰十二指肠切除术是治疗壶腹周围癌的主要方式，但该手术对于壶腹部癌和胰头癌的疗效有所差别．将我院近7年收治病例的情况报道并分析如下。     

胰十二指肠切除术治疗胰头和壶部癌230例分析

目的：了解胰十二指肠切除术治疗胰头和壶腹部癌的效果和影响病人生存的因素。方法：分析２３０例胰头和壶腹部癌的主要表现、辅助检查、手术并发症、手术死亡率，调查术后生存情况及影响病人长期生存的因素。结果：本组病人出现黄疸９０．９％，腹痛５６．１％。手术并发症７２例（３１．３％），死亡２０例（８．７％）。术后１、３、５年存活率分别为４６．７％，１７．４％和５２％。肿瘤直径、淋巴结转移和切缘状态是影响病人术     

胰十二指肠切除术治疗胰头和壶腹部癌（230例分析）

为了解胰十二指肠切除术治疗胰头和壶腹部癌的效果。我们分析了230例胰头和壶腹部癌的主要表现，辅助捡查，手术并发症．手术死亡率．调查术后生存情况及影响病人长期存活的因素。结果发现病人出现黄疸909％，腹痛56．1％，发热32．6％．白陶土样大便13．5％。B超、CT和ERCP检查准确率分别为68．3％、79．3％和66．6％。手术并发症72例（313％)，手术死亡20例(87％)。手术并发症与出血量，营养状况，手术时间和手术操作有关系。术后1年，3年和5年存活率分别为46．9％．17．4％和5．2％，肿瘤直径，淋巴结转移和切缘状态是影响病人术后生存的因素．而肿瘤分化程度和病人年龄对生存率无明显影响。结果提示：胰头和壶腹部癌临床表现有多样性，B超和CT等辅助捡查有局限性，手术有并发症和死亡率高的危险性，5年生存率低等特性．其手术治疗远近期效果都不理想。     

胰十二指肠切除术治疗胰头和壶腹部癌230例分析

了解胰十二指肠切除术治疗胰头和壶腹部癌的效果和影响病人生存的因素。方法:分析230例胰头和壶腹部癌的主要表现,辅助检查、手术并发症、手术死亡率,调查术后生存情况及影响病人长期生存的因素。结果:本组病人出现黄疽90.9％,腹痛56.1％,发热32.6％,白陶土样大便13.5％。B超、CT和ERCP检查准确率分别为68.3％、79.3％和66.6％。手术并发症72例(31.3％),死亡20例(8.7％)。术后1、3、5年存活率分别为46.7％,17.4％和52％。肿瘤直径、淋巴结转移和切缘状态是影响病人术后生存的因素,而肿瘤分化程度和病人年龄对生存率无明显影响。结论:胰头和壶腹部癌临床表现有多样性,B超和CT等辅助检查有局限性,手术有高并发症,5年生存率低下,手术治疗远近期效果都不理想。     

胰十二指肠切除术治疗胰头和壶腹周围癌

胰十二指肠切除术治疗胰头和壶腹周围癌上海市金山县中心医院外科（２０１５００）胡军，金庆丰胰十二指肠切除术是治疗可切除胰头和壶腹周围癌的首选手术方式。近年来一些文献报告手术并发症和死亡率有所降低，但仍偏高。我们自１９７７年１月～１９９１年１２月，对３７...     

胰头壶腹部癌86例手术治疗体会

胰头壶腹部癌８６例手术治疗体会温州医学院附一院（３２５０００）张启瑜，宋其同我科于１９８１～１９９３年间共收治胰头壶腹部癌８６例，行胰头十二指肠切除３１例，姑息性内引流术４９例，活检６例。全组无手术死亡，住院死于术后并发症６例。现就本组治疗情况报道如...     

对壶腹部癌行保留十二指肠升部的胰头十二指肠切除术

对46例壶腹癌患者采取保留十二指肠升部的胰头十二指肠切除术,取得满意效果,现总结如下.     

改良胰十指肠切除术治疗16例胰头及壶腹周转癌疗效观察

对１６例可切除胰头及壶腹周围癌行保留幽门的改良胰十二指肠切除术进行分析。结果表明，与传统术式相比，改良胰十二指肠切除术不但缩短了手术时间，而且不顾病你术后营养状况，减少术后并发症的发生。同时５年和３年生存率分别为１８．７％和３１．２％，与传统方法相近，因此，对肿瘤较小的胰头及壶腹周围癌，宜首选保留幽门的改良胰十二指肠切除术。     

腹腔镜胰十二指肠切除术治疗壶腹部肿瘤：附35例报告

背景与目的:近年来采用腹腔镜下胰十二指肠切除术(LPD)治疗壶腹部肿瘤取得了较好的临床效果。笔者总结所在科室LPD治疗壶腹部肿瘤的经验及体会,以供临床供参考。方法:回顾性分析本院2015年1月—2018年12月收治的35例行LPD术的壶腹部肿瘤患者的临床资料。35例患者中,十二指肠乳头腺癌32例,壶腹癌1例,十二指肠间质瘤1例,十二指肠乳头处神经内分泌肿瘤1例。结果:30例顺利行LPD术,5例因腹腔组织粘连严重、结构不清晰中转开腹;消化道重建采用Child法行胰管-空肠黏膜对黏膜吻合33例,行胰-空肠端-端套入吻合2例。31例术后均恢复良好,3例因术后胰瘘行再次手术,1例因术后消化道溃疡出血行再次手术,术后恢复良好出院。35例随访1～48个月,平均随访32个月,死亡22例,死亡时间为术后5～27个月。平均生存期42.2个月,中位生存期43.0个月。结论:壶腹部肿瘤患者行LPD治疗围术期无病死情况发生,并发症发生率较低,安全性较好,值得临床推广应用。     

Vater壶腹结石嵌顿的术中处理

目的探讨Vater壶腹结石嵌顿的术中处理技巧。方法回顾性分析2003年8月~2006年12月共35例此类病人的临床资料。30例经胆总管下段切开取石,2例行经十二指肠Odd i括约肌切开取石,3例行胆道镜下微爆破碎石仪碎石术。结果所有手术均成功,无一例病人出现大出血、胆漏、肠漏等严重的并发症。平均随访18个月,均无腹痛及胆总管结石复发。结论Vater壶腹嵌顿结石的处理应根据病人病情及医疗条件抉择,在剖腹术中采取经胆总管下段切开取石较为简便和安全。     

Signet-Ring Cell Carcinoma of the Ampulla of Vater: Report of a Case

An 83-year-old man was admitted to our hospital complaining of general fatigue, fever, and obstructive jaundice. Percutaneous transhepatic bile duct drainage was performed. Gastroduodenal fiberscopy revealed carcinoma of the ampulla of Vater, and early gastric cancer was suspected. A pancreatoduodenectomy with lymph node dissection was performed. Although a biopsy specimen from the gastric lesion was suspected to be well-differentiated adenocarcinoma, no cancerous lesion was found in a specimen resected from the stomach. The histopathologic findings of the ampullary lesion were compatible with a diagnosis of signet-ring cell carcinoma. This is a rare lesion, and a review of the literature revealed only three previous similar cases. Received: May 1, 2001 / Accepted: March 5, 2002 RID="*" ID="*" Reprint requests to: N. Eriguchi (address 1)     

Ectopic pancreas presenting as ampulla of Vater tumor

Ectopic pancreas is relatively rare and is defined as pancreatic tissue that is situated abnormally, has no contact with the normal pancreas, and has its own ductal system and blood supply. It is usually an incidental finding in clinical practice. Most patients with an ectopic pancreas are asymptomatic, and, if present, symptoms are nonspecific and depend on the site of the lesion and the different complications encountered. Heterotopic pancreatic tissue has been found in several abdominal and intrathoracic locations, most frequently in the stomach (25%-60%) or the duodenum (25%-35%). Herein, we report a patient presenting with symptoms of ampullary tumor with obstructive jaundice, but the imaging study did not suggest the possibility of ectopic pancreas preoperatively.     

老年胰头癌和壶腹周围癌行胰十二指肠切除术的临床效果

目的 探讨胰头癌及壶腹周围癌老年患者施行胰十二指肠切除术的安全性及临床疗效。方法 对2007年2月至2015年6月于我科施行胰十二指肠切除术的69例临床资料进行回顾性分析。结果 术前老年组患者（≥65岁,38例）较中青年组患者（＜65岁,31例）基础疾病多（P＜0.05）,前白蛋白明显低（P＜0.05）。所有患者均成功施行Whipple手术。两组患者术中出血量、术中输血量、术后并发症发生率均无统计学差异 （P＞0.05）;老年组手术时间、术后住院时间较长（P＜0.05）。两组患者均顺利恢复,无围手术期死亡,术后1年、3年生存率无统计学差异（P=0.26）。结论 针对胰头癌及壶腹周围癌的老年患者,施行胰十二指肠切除手术是安全、可行的,其临床疗效与中青年患者无差异。     

Pancreatic invasion is a prognostic indicator after radical resection for carcinoma of the ampulla of Vater

Sixty-three patients who had undergone pancreatoduodenectomy for carcinoma of the ampulla of Vater were analyzed with respect to tumor extent and prognosis. The postoperative mortality rate was 3% and overall survival rates 3 and 5 years after surgery were 55% and 46%, respectively. pTNM stage did not reflect prognosis after resection in patients at stages 2 and 3, while pancreatic invasion and regional lymph node metastasis clearly reflected prognosis after resection. Of the 26 patients who had no pancreatic invasion, regional lymph node metastasis was seen in only 19%, whereas of the 37 patients with pancreatic invasion, 62% exhibited lymph node metastasis. These factors were significantly correlated (P<0.001). Pancreatic invasion appeared to be an indirect indicator of regional lymph node metastasis. We conclude that, to improve prognosis for patients with pancreatic invasion, extended resection including extended lymphadenectomy, is a preferable additional procedure.     

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目的 探讨胰头癌外科治疗的效果。方法 回顾性分析255例施行手术的情况。根治性切除术153例中，胰十二指肠切除术128例，扩大胰十二指肠切除术20例，全胰切除术5例；姑息性手术102例中，胆肠Roux-Y吻合术33例，胆肠T管架桥内引流术69例。结果 手术切除率在70年代为10％，80年代为20％，90年代为30％。手术并发症各年代分别为50％、30％、20％。尤其是胰漏发生率自70年代25％到90年代明显下降为5％。手术死亡率各个年代分别为15％、8％、5％，而5昕生存率则从5％、8％提高到90年代的105。结论 手术操作的不改进和积累，术前对病情的评估和准备以及术中和术后的综合治疗是提高效果的关键。     

扩大Vater壶腹部切除的根治术治疗壶腹部肿瘤

目的 探讨Vater壶腹部肿瘤行壶腹部扩大切除的根治性手术的方法,以减少非肿瘤器官切除,并符合肿瘤治疗原则。方法 总结1995-1998年手术切除的根治术的经验。经十二指肠后外侧入路,整块切除肝外胆道、胆胰管汇合部,壶腹部及十二指肠乳头,十二指肠乳头封闭术。胆、胰、十二指肠间置空肠或胆、胰空肠Roux-en-Y吻合术。结果 围手术期死亡1例。并发症1例经再手术治愈。随访术后半年以上病人9例,最长生存29个月,无并发症及转移征象。结论（1）该术式符合胰十二指肠解剖关系;（2）按肿瘤治疗原则能达到广泛程度清扫;（3）初行该术式者应掌握胰十二指肠切除术。     

综合治疗中晚期胰头癌38例体会

目的 探讨中晚期胰头癌综合治疗效果。方法 对我院2001年1月至2007年10月无法手术切除的38例中晚期胰头癌行高位肝胆管空肠吻合术和胃空肠吻合术，术中同时行肿瘤局部无水酒精消融和腹腔神经丛无水酒精阻滞及区域动脉置管皮下埋泵术后化疗等综合治疗（简称为综合组），并就治疗效果与同期单纯行胆肠内引流治疗（简称为单纯组）的39例病人进行对比分析。结果 综合治疗组病例未增加手术并发症，术后疼痛缓解率和肿瘤缓解率有显著性提高，综合组半年、1年、2年生存率为94．37％、51．62％和7．02％。单纯组半年、1年、2年生存率为61.8％、17．34％和0。结论 综合治疗有助于延长中晚期胰腺癌病人的生存期和减轻病人疼痛、提高病人生活质量。     

Pylorus-preserving pancreatoduodenectomy is applicable to patients with carcinoma of the head of the pancreas: Studies of lymph node metastasis and quality of life

Metastases to the regional lymph nodes of the stomach were studied in patients in whom carcinoma of the head of the pancreas had been resected (51 standard pancreatoduodenectomy and 26 total pancreatectomy). Involvement of gastric lymph nodes was rare (1.3%–3.9%), except of the subpyloric lymph nodes (9.1%). Carcinoma in the five patients with positive gastric lymph nodes, with the exception of the subpyloric nodes, was clinically far advanced: four of the five had liver metastasis or peritoneal dissemination. This suggests that, in terms of preservation of the regional gastric lymph nodes, only subpyloric node involvement has any significance with respect to surgical treatment of carcinoma of the head of the pancreas. There was no significant difference in survival rates after curative resection between standard pancreatoduodenectomy (n=44) and pylorus-preserving pancreatoduodenectomy (n=17). In the patients who underwent the pylorus-preserving pancreatoduodenectomy for various kinds of periampullary diseases (n=47), postoperative recovery of gastric and small bowel function was temporarily prolonged compared to that after shandard pancreatoduodenectomy (n=44). However, the former group were able to take significantly more calories 6 weeks after the operation. Our study indicates that the pylorus-preserving pancreatoduodenectomy with subpyloric lymph node dissection is applicable to the treatment of patients with carcinoma of the head of the pancreas from the viewpoints of both extent of operation and quality of life.