165例胰十二指肠切除患者临床与病理分析

目的　探讨影响胰十二指肠切除术对壶腹周围癌患者预后的因素。方法　 16 5例壶腹周围癌患者 ,其中壶腹癌 6 9例 ,远端胆管癌 32例 ,胰腺癌 4 8例 ,十二指肠癌 16例 ,均行胰十二指肠切除。保留幽门5 5例 ,不保留幽门 110例。结果　本组 30d病死率为 4 .8% ,住院期间病死率为 6 .7%。切缘无癌组织 135例 ,5年生存率 2 9% ;切缘有癌组织 30例 ,5年生存率 6 %。淋巴结无转移 85例 ,5年生存率 35 % ;淋巴结转移 80例 ,5年生存率 2 0 %。肿瘤直径 <3cm者生存时间长。结论　胰十二指肠切除术后患者预后与切缘是否干净、淋巴结是否转移及肿瘤大小有关。 5年生存率壶腹癌患者最高 ,胰腺癌最差。保留与不保留幽门患者预后相似。

Clinical and pathological analyses of pancreaticoduodenectomy in 165 cases with periampullary carcinoma

Objective To study prognostic factors for survival after pancreaticoduodenectomy(PD) in patients with periampullary carcinoma.Methods 165 patients undergoing PD for ampullary carcinoma(n=69),distal bile duct carcinoma(n=32),pancreatic carcinoma(n=48),duodenal carcinoma(n=16).The pyloruspreserving modification of Whipple(PPPD)procedure was 55 patients.The conventional operation was performed in 110 patients.Results Thirty day mortality was 4.8%,and hospital mortality was 6.8%.Patients with negative margins (n=135) ,had a 5 year survival of 29%,whereas those resected with positive margins(n=30),had a 5 year survival of 6%.Patients resected with negative lymph(n=85),had a 5 year survival of 35%,those resected with positive lymph(n=80),had a 5 year survival of 20%.The patients with tumors less than 3 cm in diameter had significantly longer median survival(P<0.05).Conclusion Negative prognostic factors were involved in clean resection margins,lymph node metastasis and tumor size.5 year survival for patients with ampullary carcinoma was singnificantly better and the patients with pancreatic carcinoma was significantly poorer.5 year survival rate in patients with PPPD is similar to those with PD.