壶腹周围癌常见术式疗效初探

目的探讨壶腹周围癌常见手术方式的疗效。方法对26例壶腹周围癌患者的临床资料进行回顾性分析,其中胰头癌17例,壶腹部癌9例。行胰十二指肠切除术4例,胆道探查,＂T＂管引流术1例,胆囊空肠吻合术8例,胆总管空肠Roux-en-y吻合术13例。结果本组胰头癌与壶腹癌手术切除率分别为11.76%（2/17）与22.22%（2/9）,总手术切除率为15.4%（4/26）,切除患者均顺利恢复出院。术后并发症：胰瘘,胆瘘1例。上消化道出血1例,无腹腔感染,无肝功能衰竭,无肝肾综合征,切口感染或脂肪液化。胸水,肺部感染各有2例。结论壶腹周围癌的手术方式中,以根治术的效果最好,而在不能行根治术的患者中,姑息性手术以胆总管空肠Roux-en-y吻合术的疗效最佳,并且胆管癌的预后优于胰头癌。

Adenocarcinoma periampullary of various surgical methods evaluation

Objective To discuss the various surgical treatments of adenocarcinoma periampullary.Methods Clinical data about 26 adenocarcinoma periampullary patients who were retrospectively analyzed,including Pancreatic head carcinoma 17 cases,adenocarcinoma periampullary 9 cases.Do pancreticoduedenectomy 4 cases,biliary exploration and the ＂T＂ tube drainage 1 case,gallbladder jejunum anastomosis 8 cases,and 12 cases by Roux-en-Y type cholangiojejunostomy.Results Group of the head of pancreas cancer with adenocarcinoma periampullary operation resection respectively 11.76%（2/17） and 22.22%（2/9）,total surgical resection for 15.4%（4/26）,and all resection patients recovered smoothly from the hospital.The postoperative complications： pancreatic fistula,biliary fistula and,upper gastrointestinal bleeding,1 case with no celiac infection,without liver failure,no hepatorenal syndrome,infection of incision or fat liquefaction,pleural effusion,lung infection has each in 2 cases.Conclusion Radicalsu is the best choice of adenocarcinoma periampullary,while in the palliativeops,Roux-en-Y type cholangiojejunostomy has better effect and cholangiocarcinomapr better than pancreatic headca.