胰腺癌手术方式的探讨

目的 探讨胰腺癌手术方式的选择。方法 回顾分析8年来209例胰腺癌患者的临床资料：胰头肿瘤149例，胰体尾肿瘤54例，全胰癌6例；行根治性胰十二指肠切除或胰体尾加脾切除术59例，姑息性胰十二指肠切除或胰体尾加脾切除术15例，内引流术64例。结果 胰腺癌根治性切除术后1年生存率42.37%，3年生存率13.56%，5年生存率6.78%，明显高于其他治疗组；姑息性切除术后1年生存率20%，3年生存率6.67%，明显高于未手术者；内引流术后1年生存率仅为9.38%，3年以上生存率为零，与未手术者无明显差异，但生存质量有所改善。结论 根据术前CT和磁共振显像（MRI）检查，对胰腺癌进行准确的术前评估和分级分期；并根据术中探查肿瘤是否侵犯血管，有无局部或远处转移，选择正确的手术方式，能显著提高患者术后生存率和有效改善其生存质量。

Study on operative methods for pancreatic carcinoma

Objective To discuss the choice of operative method for pancreatic carcinoma.Methods The clinical data of 209 cases of pancreatic cancer treated within 8 years were retrospectively analysed. Among the cases, 149 cases of tumor of haed of pancreas, 54 cases of tumor of body and tail of pancreas, and 6 cases of cancer of entire pancreas. The operations performed were radical pancreaticoduodenectomy in 59 cases, palliative pancreaticoduodenectomy or distal pancreatectomy with splenectomy in 15 cases, and internal drainage in 64 cases.Results After radical excision of pancreatic cancer, the 1-,3-,and 5-year survival rate was 42.37 %, 13.56 % and 6.78 %, respectively, which was higher than the 20.00 %, 6.60 % and 0 %, respectively, after palliative resection. After internal drainage, the 1-and 3-year survival rate was 9.38 % and 0 %,respectively, which was not different from cases without operation, but their quality of life was improved.Conclusions Marked increase in postoperative survival rate and improvement in quality of life can be achieved by correct pre-operative assessment and staging of pancreatic cancer by CT and MRI studies and correct selection of operative method.