346例胰头癌外科治疗40年回顾

目的比较不同年代胰头癌外科治疗情况,总结治疗经验.方法回顾性分析1958～2003年在我院外科接受治疗的346例胰头癌患者的临床资料.结果1958～1976、1977～1987、1988～1998及1999～2003年胰头癌切除率分别为26.6%(21/79)、26.7%(16/60)、20.2%(22/109)及22.4%(20/98),总切除率为22.8%(79/346),未能切除病例多采用胆囊十二指肠吻合术解除胆道梗阻.1958～1976、1977～1987、1988～1998及1999～2003年胰十二指肠切除术后并发症发生率分别为42.3%(9/21)、37.5%(6/16)、27.3%(6/22)及10.0%(2/20).1958～1976年手术死亡率为19.0%(4/21),原因为胰瘘(2例)、肝肾功能衰竭(1例)和胆道感染(1例);1977～1987年手术死亡率为12.5%(2/16),原因为胰瘘及多器官功能衰竭(各1例);1988～1998年手术死亡率为4.5%(1/22),原因为多器官功能衰竭(1例);1999～2003年20例胰十二指肠切除术无围手术期死亡病例.1958～1976年胰头癌胰十二指肠切除术后1、3及5年存活率分别为55.5%、23.1%及11.0%,1977～1987年分别为56.3%、25.0%及12.5%,1988～1998年分别为59.1%、27.2%及13.6%.结论由于围手术期治疗和监护技术的进步,手术技术操作的成熟,胰头癌手术死亡率和并发症发生率均有显著下降,但手术切除率和生存率没有显著变化.

Surgical treatment of pancreatic head carcinomas

Objective To compare the outcomes of patients undergoing surgical treatment for panc- reatic head carcinomas during different time course over 40 years in one hospital. Methods Totally 346 cases of pancreatic head carcinoma in one hospital were retrospectively analyzed during the periods of 1958-1976, 1977-1987, 1988-1998, and 1999-2003. Results During the period of 1958-1976, 79 patients with pancreatic head carcinoma were diagnosed and the rate of pancreaticoduodenectomy(PD)was 20.6%(21/79). During the period of 1977-1987, 60 patients with pancreatic head carcinoma were diagnosed and the PD rate was 26.7%(16/60). During the period of 1988-1998, 109 patients with pancreatic head carcinoma were diagnosed and the resection rate was 20.18%(22/109). During the period of 1999-2003, 98 patients with pancreatic head carcinoma were diagnosed and the resection rate was 22.4%(20/98). The total resection rate of pancreatic head carcinomas was 22.8%(79/346). The complication rate of the operation was 42.3%(9/21)during 1958-1976, 37.5%(6/16)during 1977-1987, 27.3%(6/22)during 1988-1998, and 10.0%(2/20)during 1998-2003. The periopera- tive mortality was 19.0%(4/21)during 1958-1976(2 cases of pancreatic fistula and 1 case of liver and renal failure),12.5%(2/16)during 1977-1987(1 case of multiple organ failure and 1 case of bleeding), and 4.5%(1/22)during 1988-1998(1 case of multiple organ failure). One patient with bile duct fistula during 1977-1987 and one patient with pancreatic fistula during 1988-1998 were cured by non-operative treatment. There was no perioperative death during 1999-2003. During the period of 1958-1976, the survival rate of patients undergoing PD was 55.5% by 1 year, 23.1% by 3 year, and 11.0% by 5 year. During 1977-1987, it was 56.3% by 1 year, 25.0% by 3 year, and 12.5% by 5 year. During 1988-1998, it was 59.1% by 1 year, 27.2% by 3 year, and 13.6% by 5 year. Conclusions Remarkable improvement have been achived in perioperative preparation and care after surgical treatment of pancreatic head cancer in the past decades. However, the resection rate and prognosis of PC were still poor, although the accuracy of early diagnosis is increasing, and the complications and perioperative mortality of PD are decreasing.