胰头癌的外科治疗：附142例报告

目的：探讨胰腺癌的外科治疗方法对其生活质量、生存时间的影响，以总结胰头癌的外科治疗经验。方法：回顾性分析1997年1月—2007年12月142例经手术治疗的胰头癌患者的临床及随访资料，142例分为根治性切除（RR）组(38例)，姑息性切除(PR)组(15例)，胆肠内引流(BJ)组(89例)。BJ组根据吻合方式再分为胆囊空肠吻合组(56例)，胆管空肠吻合组(33例)；是否附加胃空肠吻合又分为BJ+胃空肠吻合组(32例)，BJ未附加胃空肠吻合组(57例)。观察各组生存时间及BJ组黄疸复发率、十二指肠梗阻发生率。结果：(1)RR，PR，BJ组的中位生存时间分别为13.6，10.7，7.8个月，RR组生存时间较PR，BJ组有明显延长（P<0.01），但PR组与BJ组生存率相比，差异无统计学意义（P>0.05）。(2)BJ组中胆管空肠吻合组生存率显著高于胆囊空肠吻合组（P<0.05）；胆囊空肠吻合组、胆管空肠吻合组黄疸复发率分别为55.4%，9.1%（P<0.01）。附加胃空肠吻合组、未附加胃空肠吻合组十二指肠梗阻发生率分别为6.2%，22.8%（P<0.05）。结论：胰腺癌患者应首选根治性切除；对不能行根治性切除者宜选择胆管空肠、胃空肠双吻合手术，以期提高其生活质量、延长生存期。

The surgical treatment of pancreatic cancer: a report of 142 cases

Objective:To investigate the effect of various operative methods for pancreatic cancer on patient′s quality of life and survival time.Methods:The clinical data of 142 patients with pancreatic cancer admitted into our hospital between 1997 and 2007 were analyzed retrospectively.The patients were divided into 3 groups:Undergoing radical resection(RR,n=38), palliative resection(PR,n=15) and biliary-jejunostomy(BJ,n=89). The BJ patients were subdivided into cholecystojejunostomy group(n=56)、 choledochojejunostomy group(n=33), gastrojejunostomy group(n=32) and no-gastrojejunostomy group(n=57) according to the differen methods of anastomosis. SPSS13.0 software package was used for survival analysis, the recurrence rate of jaundice and obstruction of duodenum.Results:The median survival time in patients undergoing RR、PR and BJ was 13.6、10.7 and 7.8 months respectively. RR group had longer survival time than PR and BJ group (P<0.01). Meanwhile,PR group had longer survival time than BJ group,but the difference was no statisfical (P>0.05) The patients receiving choledochojejunostomy had longer survival time than the patients undergoing cholecystojejunostomy(P<0.05). Moreover, the former had lower recurrence rate of jaundice than the latter(P<0.01). The gastrojejunostomy group had lower rate of duodenumal obstruction(P<0.05).Conclusions:Radical resection should be regarded as the first choice for the patients with pancreatic cancer. For those patients who cannot urdergo radical resection, the selection of biliary-jejunostomy and gastrojejunostomy(double bypass) is more conducive to better quality of life and longer survival time.