专业组与非专业组胰十二指肠切除之比较

目的探讨胰腺专业组与非专业组胰十二指肠切除术（PD）有无差别。方法回顾性分析我院自1986年成立胰腺专业组以来至2003年276例胰十二指肠切除术资料，其中专业组行PD197例，非专业组行PD79例。结果专业组与非专业组手术切除率、切缘阳性率、胰瘘发生率、平均切除肿瘤大小、平均清除淋巴结数、平均术中输血量、平均手术时间、术后平均住院时间、术后平均生存期、手术死亡率分别为42．7％、8．63％、2．54％、3．11cm、9．01、980ml、6．4h、17．1d、25．7个月、1．52％和28．4％、20．25％、10．12％、2．77cm、5．45、1340ml、5．46h、23．6d、17．8个月、8．86％，有显著性差异（P〈0．05或P〈0．01），而在胆瘘、出血、胃潴留、感染方面无显著性差异。结论宜成立胰腺诊治中心或专业组，集中收治胰腺病人，以提高手术安全性和规范性。主张根治术和扩大根治术，提高疗效。

Comparison of results of pancreaticoduodenectomy between pancreatic specialty group and non-pancreatic specialty group

Objective To compare the results of pancreaticoduodenectomy for periampullary cancer between the pancreatic specialty group(group A) and non-pancreatic specialty group(group B).Methods The clinical data of 276 patients underwent pancreaticoduodenectomy in our hospital from 1986,when the pancreatic specialty group was established,to 2003 were retrospectively analyzed.Meanwhile,the results of the operation were compared between the 197 cases done by group A and 79 by group B.Results The surgical resection rate,positive rate of resection margin,pancreatic fistula rates and the average excised tumor size,dissected lymph nodes,unit of blood transfusion in operation,operative time,postoperative hospitalization duration,postoperative survival time and operative mortality were 42.7%,8.63%,2.54%,3.11 cm,9.01,980 ml,6.4h,17.1 d,25.7 months,1.52% and 28.4%,20.25%,10.12%,2.77cm,5.45,1340ml,5.46h,23.6 d,17.8 months,8.86% in group A and group B,respectively.There were significant differences between the 2 groups(P<0.05).However,there were no marked differences in occurrence of bile fistula,gastrointestinal & intra-abdominal hemorrhage,gastroparalysis and infection between the 2 groups.Conclusions It is advisable to establish pancreatic center or pancreatic specialty group for diagnosis and treatment of pancreatic diseases for the purpose of improving operative safety and standardizing the procedure of pancreaticoduodenectomy.Radical pancreaticoduodenectomy or extended radical pancreaticoduodenectomy should be performed for periampullary cancer.