保留幽门的胰十二指肠切除术治疗壶腹周围癌47例报告

目的总结保留幽门的胰十二指肠切除术(PPPD)治疗壶腹周围癌的临床效果。方法将47例PPPD与同期127例经典的胰十二指肠切除术(PD)作对照研究，分析两组的术后并发症及生存率。结果PPPD组与PD组术后并发症发生率分别为34.0%和27.6%，其中胃排空延迟发生率分别为8.5%及6.3%，均无显著差异；术后5年生存率分别为47.3%和41.4%，无统计学差异。Ⅰ、Ⅱ期肿瘤的5年生存率为59.3%，而Ⅲ、Ⅳ期肿瘤5年生存率仅为6.8%，两者差异显著(P<0.01)。结论对于无明显胰外浸润转移的胰头癌及壶腹部癌患者可施行PPPD。

Pylorus-preserving Pancreaticoduodenectomy in Pancreatic and Periampullary Carcinomas(Report of 47 Cases).

To evaluate the results of pylorus-preservingpancreaticoduodenectomy(PPPD) in the treatment of selected patients with carcinoma of the head of pancreas or of the periampullary region. Methods: From Dec 1984 to Dec 1999, 174 patients with carcinoma of the head of pancreas or of the periampullary region underwent either PPPD(n=47) or standard pancreaticoduodenectomy (PD, n=127); short- and long-term results were compared between the two groups. Results: The incidence of post-operative complications was 34.0% in the PPPD group and 27.6% in the PD group, and the rate of delayed gastric emptying as 8.5% and 6.8%, respectively. There were no significant differences in actuarial survival curves between PPPD and PD, the 5-year survival rate was 47.3% after PPPD and 41.4% after PD. But for patients in stages III and IV, the 5-year survival rate was significantly lower as compared to patients of stages I and II. Conclusions: PPPD might be an acceptable alternative to PD in the treatment of cancer of the head of pancreas or of the periampullary region, if the proximal duodenum or peripyloric lymph nodes were not involved.