进展期胃下部癌并胰头转移行改良Whipple术式的临床研究

目的探讨进展期胃下部癌（APGC）侵犯胰头的手术治疗重建术式及临床效果。方法前瞻性对比研究1993-2006年收治的48例APGC侵犯胰头患者的临床资料,将其中26例确诊为APGC且行手术治疗的患者分为两组：治疗组（12例）术中行联合胰头切除的改良Whipple扩大根治术;对照组（14例）术中采用姑息性胃大部切除术。观察两组的手术效果。结果治疗组术后未发生胰瘘、大出血、胆汁碱性反流性胃炎和食管炎以及胆道逆行感染;对照组术后发生大出血（3例）、胆汁碱性反流性胃炎和食管炎所致的上腹部烧灼痛（14例）。治疗组和对照组患者的1、3、5年生存率分别为11/12、6/12、4/12和3/14、0和0,差异有显著性意义（P〈0.01）。结论联合胰头切除的改良Whipple扩大根治术手术效果好,可明显延长APGC侵犯胰头患者的生存期。

Clinical Study of the Improved Whipple Technique in Reconstruction of Advanced Part-Inferior Gastric Cancer with Pancreatic Head Metastasis

Objective To investigate the clinical effect and surgical operation reconstruction technique for advanced part-inferior gastric cancer (APGC) with pancreatic head invasion.Methods Prospective contrast study was used to investigate the data of 48 patients with APGC with infringement pancreatic head,among them 26 patients diagnosed as having APGC and also received surgical operation were divided into two groups: trial group (12 examples) in the technique line of union pancreatic head excision improvement Whipple expansion rootgoverning skill,control group (14 examples) in the technique line of the appeasing stomach big excision method.The surgery effects of the two groups were analyzed.Results In trial group there were on occurrence of pancreas fistula,massive hemorrhage,bile alkalinity regurgitation gastritis and esophagitis as well as biliary duct retro-infection after treatment; while in control group there were the massive hemorrhage (3 examples),and gastric burning pain due to the bile alkalinity regurgitation gastritis and the esophagitis (14 examples).The 1,3,5 years survival rates in the trial group were respectively 91.7% (11/12),50% (6/12),33.3% (4/12),and in the control group were respectively 21.4% (3/14),0 (0/14) and 0 (0/14),with a significant difference between the two groups (P<0.01).Conclusion The union pancreatic head excision improvement Whipple expansion root governing skill can obviously lengthen the life time of APGC infringement pancreatic head patient.