胃幽门窦癌浸润胰头联合胰十二指肠切除43例临床分析

目的探讨胃幽门窦癌浸润胰头时的手术方法。方法回顾性分析1984年6月至2004年6月收治的采用胰十二指肠切除术(PD)治疗的胃癌侵及胰头43例临床资料。结果无手术死亡。19例根治手术中联合胰十二指肠切除术15例,胰头局部切除4例;姑息切除17例;探查及胃空肠吻合7例。术后并发症发生率:PD术后为33%(5/15),胰头部分切除为25%(1/4),姑息切除为18%(3/17),探查活检为14%(1/7)。组间差异无显著性意义(P>0·05)。随访:中位生存时间PD为26个月(12~156个月),胰头部分切除为23个月(14~73个月),姑息切除为8个月(3~37个月),探查及胃空肠吻合为3个月(1·5~9·0个月)。联合PD和胰头部分切除的生存期明显长于姑息切除和探查及胃空肠吻合组(P<0·01)。结论胃幽门窦癌联合PD或胰头局部切除能够提高病人的生存期,手术指征选择恰当和肿瘤的彻底根治是取得良好临床效果的关键。

Pancreatoduodenectomy for advanced gastric cancer with tumor invading the pancreatic head:a clinical analysis of 43 cases

Objective To investigate the surgical treatment of the gastric cancer invading the pancreas head.Methods The clinical data of 43 patients with gastric cancer invading the pancreas head admitted between June 1994 and June 2004 were analyzed retrospectively.Results Of the 43 patients with tumor invading the pancreatic head,15 patients underwent radical resection with PD, 4 patients underwent radical resection with a lesser pancreatic resection,17 patients underwent palliative resection and 7 patients underwent only an exploration or a bypass surgery.The postoperative complication rates were 33%(5/15) in PD group,25%(1/4) in a lesser pancreatic resection group,18%(3/17) in palliative resection group and 14%(1/7) in an exploration or a bypass surgery group respectively (P>0.05).No perioperative death occurred.The median survival time was 26 (12-156) months in PD group,23(14-73) months in a lesser pancreatic resection group,8(3-37) months in palliative resection group and 3(1.5-9) months in an exploration or a bypass surgery group respectively.Conclusions As for the patients with gastric cancer invading the pancreas head,radical resection with PD or with a lesser pancreatic resection can improve the patient's survival time.The selection of operation indications and the radical resection is crucial to the prognosis.