高龄壶腹周围癌患者姑息性旁路手术与根治性手术治疗围手术期观察

目的：评价姑息性旁路手术与根治性手术治疗高龄壶腹周围癌患者的临床疗效，探讨其临床适用性。方法回顾性分析行手术治疗的高龄壶腹周围癌患者的临床资料及随访结果，根据手术方式随机抽取122例，分为根治性手术组试验组（62例）和姑息性旁路手术组对照组（60例）。观察并记录两组患者的一般情况，术后及随访中并发症情况、分析两组的中位生存期和1年、3年、5年的生存率。结果试验组患者的手术时间、术中出血量、平均住院天数和输血率均明显优于对照组，差异均有统计学意义（ P ＜0．05）；试验组患者并发症发生率（24．2％）明显高于对照组（10．0％），差异有统计学意义（χ2＝74．31，P＜0．05）；试验组和对照组的中位生存期分别为（2．1±0．2）年和（0．6±0．3）年，差异有统计学意义（P＜0．05），试验组术后1年、3年、5年的生存率均优于对照组，差异显著，具有统计学意义P＜0．05）。结论根治性手术和姑息性旁路手术治疗高龄壶腹周围癌各有利弊，临床上应遵循个体化的原则，选择最适合患者的手术方式。

Observation of Perioperative Period of Palliative Bypass Surgery and Radical Surgery for Elderly Patients with Periampullary Cancer

Objective To evaluate the clinical efficacy of palliative bypass surgery and radical surgery for elderly pa -tients with periampullary cancer ,and to explore its clinical applicability .Methods Retrospective analysis of clinical data and fol-low-up results of periampullary cancer patients treated with surgical treatment were conducted ,and 122 cases according to the sur-gical way were divided into radical surgery group (62 cases) and palliative bypass surgery group (60 cases).General situation of the 2 groups,postoperative complications,and follow-up were observed and recorded ,median survival and 1-,3-,5-year survival rates of the 2 groups were analyzed.Results The operation time,intraoperative bleeding volume,average days of hospitalization and transfusion of the observation group were significantly higher than those of the control group ,the difference was statistically significant(P<0.05);the incidence of complications in the observation group (24.2%) was significantly higher than that of the control group(10.0%),the difference was statistically significant (χ2 =74.31,P<0.05);the median survival of the observation group and the control group were(2.1 ±0.2) year and(0.6 ±0.3) year,the difference was statistically significant(P<0.05), 1-,3-,5-year survival rates of the observation group were better than those of the control group ,the difference was statistically sig-nificant(P<0.05).Conclusion Radical surgery and palliative bypass surgery for elderly patients with periampullary cancer have advantages and disadvantages ,we should follow the principle of individualization ,and choose the most suitable mode of oper-ation patients .