十二指肠癌的诊治分析

目的 提高十二指肠癌的诊治水平。方法 对45例十二指肠癌的诊治方法及预后作用回顾性分析。结果 行纤维十二指肠镜检查的十二指肠癌确诊率为95%（20/21），十二指肠X线低张造影检出率为96%（22/23），腹部B超及CT的检出率分别为29%（13/45）及73%（19/26），5例行核磁共振（MRI）检查，4例显示肿瘤。手术治疗44例，肿瘤切除率为53%（24/45），根治性切除率为42%（19/45）。根治术后1、3、5年生存率分别为91%、39%、26%，肿瘤未切除组的中位生存期仅为5个月。结论 联合应用纤维十二指肠镜和十二指肠低张造影能较理想地诊断各段十二指肠肿瘤。B超、CT及MRI均能判断梗阻性黄疸者的梗阻部位，且有助于检出转移瘤。手术切除肿瘤是有效的治疗方法。     

胰头囊性肿瘤的手术策略15例报告

目的探讨胰头部囊性肿瘤的治疗策略。方法回顾性分析2000年1月至2009年12月收治的15例胰头部囊性肿瘤患者的临床资料。结果上腹饱胀不适及黄疸为胰头部囊性肿瘤患者最主要的症状。术前超声检出率为80%（12/15）,CT检出率为100%。所有患者均接受手术治疗,手术方式包括肿瘤局部切除、胰十二指肠切除、保留幽门的胰十二指肠切除及胆总管空肠吻合。术后并发症率53.3%（8/15）,随访率86.7%。结论对胰头部囊性肿瘤,术前CT或MRI检查及术中冰冻病理检查非常重要,根据上述情况采取个体化的手术方式。     

十二指肠腺癌89例临床分析

目的 探讨原发性十二指肠腺癌的诊断和根治术术式选择.方法 对1985-2009年经手术切除、病理证实的89例十二指肠腺癌患者的临床资料进行回顾性分析.结果 十二指肠腺癌发病率低,临床表现缺乏特异性,术前内镜确诊率为93%,胃肠X线气钡造影为90%,磁共振胰胆管造影为82%,B超为42%,MRVCT为70%.肿瘤位于十二指肠第2段占65%.48例行胰十二指肠切除,19例行十二指肠节段切除,切除术后患者5年生存率分别为47%和50%.结论 内镜和X线气钡双重造影是诊断十二指肠腺癌的主要检查方法.早期诊断和根治手术是提高切除率和疗效的主要途径.

Abstract：

Objective To evaluate the preoperative diagnosis and treatment of primary duodenal adenocarcinoma ( PDA). Methods Clinical data of 89 PDA cases undergoing laparotomy from 1985 to 2009 in three hospital in Beijing and Zhengzhou were analyzed retrospectively. Results The prevalence rate of PDA is comparatively low and its clinical manifestations are not specific. The correct diagnostic rate of auxiliary examination were 93% by endoscopy,90% by gastrointestinal X-ray air barium double radiography,82% by MRCP,42% by BUS,70% by CT/MRI. The most common location of the adenocarcinoma(65% ) was at the second portion of the duodenum. Among 67 PDA cases 48 cases underwent pancreatoduodenectomy, 19 cases received segmental deodenectomy. The 5 year's survival rate was 47% and 50% respectively. Conclusions Endoscope and X-ray radiography are mainstays for the diagnosis of PDA. Early diagnosis and radical operation are the key to improve the resection rate and the long term survival.     

胰十二指肠联合血管切除和重建治疗胰头部恶性肿瘤

目的探讨联合血管重建胰十二指肠切除术的适应证和方法。方法回顾 1994年4月～ 2 0 0 1年 3月多家协作医院 4 4例联合血管重建胰十二指肠切除术的资料。本组 4 4例行胰十二指肠切除 ,全组均联合肠系膜上静脉 门静脉切除 ,其中合并肠系膜上动脉和肝动脉切除重建者分别为 4例和 2例。 1例胰头癌因与下腔静脉前壁粘紧不能分开则合并下腔静脉前壁部分切除修复。结果本组围手术期死亡 3例 (7% )。无胆、胰瘘及人工血管感染发生。病理检查结果 :胰腺神经内分泌恶性肿瘤 1例 ,其余均为腺癌。切除血管内膜和胰腺边缘均无肿瘤侵润。本组失访 2例。随访时间 3～ 87个月 ,7例死于术后 7个月至 3年 ,其中 6例为合并肠系膜上动脉和肝动脉切除重建者。存活超过 3年者 2 1例 ,超过 5年者 6例 ,其余病例尚在随访中。结论在选择适宜的病例中施行联合切除血管的胰头癌根治术可提高其切除率 ,延长存活时间 ,手术安全。     

原发性十二指肠肿瘤的诊断和治疗

目的 探讨原发性十二指肠肿瘤(PTD)的诊断和术式选择.方法 对北京丰台医院1995-2005年间52例PTD的诊断和手术治疗等临床资料进行回顾性分析.结果 术前行十二指肠镜检查42例,发现肿瘤38例(90.5%);行气钡双重造影40例,发现肿瘤32例(80%).良性肿瘤6例,均行十二指肠切开、肿瘤局部切除,术后5年生...     

胰十二指肠切除术后不同胰肠吻合方式的效果与评价

目的比较胰十二指肠切除术后三种不同胰肠吻合方式的胰肠吻合口瘘发生率,探讨实施不同吻合方式的适用条件及其合理性。方法回顾性分析92例胰十二指肠切除术患者的临床资料。按吻合方式不同分为捆绑式胰肠吻合组(A组)、胰管对空肠粘膜端侧吻合组(B组)和套入式端侧吻合组(C组),观察其术后胰瘘的发生率。结果胰肠吻合口瘘的发生率为:A组1例(1/41,2.44%);B组无胰肠吻合口瘘发生;C组3例(3/19,15.79%)。A、B两组间胰肠吻合口瘘发生率无统计学差异(P>0.05);C组胰肠吻合口瘘发生率显著高于A、B两组,差异有统计学意义(P<0.05)。结论胰管对空肠粘膜吻合法和捆绑式吻合法均为较安全的胰肠吻合方法。在条件许可下,胰管对粘膜吻合法应作为胰十二指肠切除术首选的胰肠吻合方法。     

Bypass Surgery Versus Palliative Pancreaticoduodenectomy in Patients with Advanced Ductal Adenocarcinoma of the Pancreatic Head, with an Emphasis on Quality of Life Analyses

Background In some centers, palliative resection (PR; partial pancreaticoduodenectomy) is, in selected cases, promoted in preference to double loop bypass (DLB) surgery for advanced pancreatic cancer. This prospective study compares PR with DLB, placing particular focus on patients’ quality of life (QoL).Methods From 01/1993 to 09/2004, 167 patients were analyzed in a prospective single center study of palliative surgical treatment of advanced ductal adenocarcinoma of the pancreatic head. Thirty-eight underwent PR and 129 underwent palliative DLB. Patients undergoing DLB were divided into: (1) locally advanced disease (LAD-subgroup; n = 61; 47%) and (2) metastasized disease (MD-subgroup; n = 68; 53%). QoL was assessed using the EORTC QLQ-C30 questionnaire supplemented by a pancreatic cancer specific module. QoL data were collected pre-operatively and for up to 12 months after surgery.Results Median survival was 7.0 months (95% CI 4.09; 9.91) in PR patients and 6.0 months (95% CI 5.39; 6.61) in patients who received DLB. Mortality and morbidity were, respectively, 7.8 and 58% for PR, and 2.6 and 42% for DLB. QoL decreased more after PR than after DLB. The DLB-group recovered quicker, reaching pre-operative QoL levels after 3 months, and were less impaired when discharged. The LAD-subgroup and the MD-subgroup presented with equal levels of QoL.Conclusions QoL analysis revealed favorable QoL data after DLB. Additionally, the survival rates of the two groups did not differ significantly, but morbidity and mortality rates in the PR group were elevated. Therefore, the use of PR for advanced pancreatic cancer needs to be carefully evaluated.     

腹腔镜与开放胰十二指肠切除术疗效的对比观察

目的：探讨腹腔镜胰十二指肠切除术（LPD）的手术和肿瘤学安全性,并与开放胰十二指肠切除术（OPD）进行疗效对比。方法回顾性分析2012年1月至2013年6月中山大学附属第三医院胃肠外科收治并行胰十二指肠切除术患者的临床资料,根据所行术式分为LPD组和OPD组,对比分析手术时间、术中出血量、清扫淋巴结数目、术后第1天腹腔引流量、术后排气时间、恢复流质饮食时间、术后发热天数、术后住院天数、术后并发症发生率、1年生存率和复发率等指标。结果两组患者性别、年龄、ASA分级、手术时间、清扫淋巴结数目、病理分期、术后发热天数、术后引流管拔除时间、术后并发症发生情况以及术后1年生存率和肿瘤复发情况等指标差异均无统计学意义（P＞0．05）。而LPD组相比OPD组,术中出血量[（168．2±87．4） ml比（353．5±140．1） ml,P＝0．000]及术后第1天腹腔引流量[（157．7±69．7） ml比（289．1±197．0） ml,P＝0．039]减少,术后排气时间[（4．1±0．9） d比（6．6±3．4） d,P＝0．024]、恢复流质饮食时间[（5．8±1．3） d比（8．2±3．5） d,P＝0．040]、下床活动时间[（3．6±1．4） d比（6．2±1．5） d,P＝0．000]和术后住院天数[（17．0±2．2） d比（25．7±13．8） d, P＝0．047）明显缩短。结论与传统开放手术相比,LPD能够保证肿瘤根治性切除和手术安全的同时,在减少术中出血和促进术后恢复过程方面具有明显优势。     

胰十二指肠切除术中胰肠吻合方式与术后胰漏及吻合口出血的相关性研究

目的分析胰十二指肠切除术（PD）中胰肠吻合方式与术后胰漏及吻合口出血的关系。方法回顾性分析2008年1月至2012年9月期间我院行PD的526例患者的临床资料。526例PD患者行胰肠吻合的方式：胰管空肠端侧黏膜对黏膜吻合（简称黏膜对黏膜吻合）359例,其中149例硅胶引流管内置（简称引流管内置）,130例硅胶引流管引流至体外（简称引流至体外）,80例硅胶引流管未放置（简称引流管未置）;胰腺空肠端侧套入式吻合165例（简称套入式吻合）,均未放置硅胶引流管;胰肠侧侧吻合2例（简称侧侧吻合）,均未放置硅胶引流管。结果526例PD患者术后共发生胰漏34例（6.46%）,胰肠吻合口出血8例（1.52%）,死亡32例（6.08%）。①黏膜对黏膜吻合的胰漏发生率明显低于套入式吻合〔4.18%（15/359）比11.52%（19/165）,χ2=10.029,P=0.002〕;黏膜对黏膜吻合与套入式吻合的吻合口出血发生率比较差异无统计学意义〔1.67%（6/359）比1.21%（2/165）,χ2=0.159,P=0.691〕。②黏膜对黏膜吻合术式中,引流管内置者和引流至体外者的胰漏发生率均分别明显低于引流管未置者〔2.68%（4/149）比11.25%（9/80）,χ2=7.132,P=0.008;1.54%（2/130）比11.25%（9/80）,χ2=9.410,P=0.002〕;引流管内置者与引流至体外者的胰漏发生率比较差异无统计学意义〔2.68%（4/149）比1.54%（2/130）,χ2=0.433,P=0.510〕。引流管内置者与引流至体外者的吻合口出血发生率比较差异无统计学意义〔2.68%（4/149）比1.54%（2/130）,χ2=0.433,P=0.510〕。结论黏膜对黏膜吻合方式胰漏的发生率明显低于套入式吻合方式,但吻合口出血的发生率无明显差异。胰管内硅胶引流管内置或引流至体外均能降低术后胰漏的发生率,但是对于吻合口出血的发生率无明显影响。     

Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials

Background

The best reconstruction method for the pancreatic remnant after pancreaticoduodenectomy remains debatable. We aimed to investigate the perioperative outcomes of 2 popular reconstruction methods: pancreaticogastrostomy and pancreaticojejunostomy.

Data Sources

Randomized controlled trials comparing pancreaticogastrostomy versus pancreaticojejunostomy were identified from literature databases (MEDLINE/PubMed, EMBASE, Web of Science, Cochrane Library).The meta-analysis included 8 studies: 607 patients who underwent pancreaticogastrostomy and 604 who underwent pancreaticojejunostomy. Postoperative pancreatic fistula and intra-abdominal fluid collection rates were significantly lower after pancreaticogastrostomy compared with pancreaticojejunostomy. No statistically significant differences were found in the incidence of delayed gastric emptying, biliary fistula, hemorrhage, reoperation, wound infection, overall morbidity, mortality, and length of hospital stay.

Conclusions

Our meta-analysis suggests that pancreaticogastrostomy not only reduces the rate of postoperative pancreatic fistula but also decreases its severity. Pancreaticogastrostomy is associated with a lower rate of intra-abdominal fluid collection. Our results suggest that pancreaticogastrostomy should be the preferred reconstruction method.