李勇 1肖卫东 1蔡军 1余永欢 1吴安涛 1李学明 1彭承宏2
作者信息
- 1. 南昌大学第一附属医院普通外科,江西南昌330006
- 2. 上海交通大学医学院附属瑞金医院普通外科,上海200025
- 折叠
摘要
Abstract
Objective To summarize the operative complications, fatality and the long-term outcome of pancreaticoduodenectomy ( PD ). Methods The clinical data of 328 consecutive patients undergoing PD between Janunary 2001 and Janunary 2011 were retrospectively analyzed, which included 281 cases of standard PD, 8 cases of pylorus-preserving PD and 39 cases of extended PD. Results The incidence of operative complications in the whole group was 34. 1% (112/328), of which the five major complications were delayed gastric emptying (16. 5% ) , pancreatic fistula (11. 9% ) , hemorrhage (7. 0% ) , intra-abdominal infection (5.2% ) and pulmonary infection (4.9% ) . The reoperation rate was 6.1% and fatality rate was 3.0%. The 1-, 3- and 5-year survival rate of the patients with periampullary carcinoma ( n =202) was 79. 1 % , 51.5% and 33.8% , respectively, and the median survival time was 38 months,of which the 1 -, 3 -, and 5 -year survival rate of the lymph node negative cases ( n = 144 ) was 81.7% , 57. 6% and 40. 6% , respectively, with a median survival time of 47 months, and the 1-, 3-, and 5-year survival rate of the lymph node positive cases ( n = 58 ) was 72. 1 % , 36. 4% and 16.8% , respectively, with a median survival time of 24 months. The long-term survival time of lymph node negative patients was significantly higher than that of lymph node positive patients ( P =0. 003 ). The 1-, 3-, 5-year survival rate of the patients with pancreatic head cancer ( n = 42) was 67. 6% , 29. 1% and 9.7%, respectively, and the median survival time was 16 months, but the 3-year survival rate of the lymph node positive cases (n = 11 ) was 0. The 1-, 2-, 3-year survival rate of the patients with nonperiampullary primary tumors (n = 16) was 71.4% , 39.6% and 19.8% , respectively, and the median survival time was 21 months. Conclusions The keys to reducing the postoperative complications and fatality of PD are strictly adhering to the indications for extended PD, improving the operative technique and strengthening the perioperative management. The lymph node status is the important factor of prognosis for periampullary and pancreatic head cancer. En bloc PD can be considered as a treatment option for nonperiampullary tumors such as locally advanced gastrointestinal cancers, because it may prolong the survival in some of these patients.关键词
胰十二指肠切除术/胰腺肿瘤/壶腹周围癌/手术后并发症/预防与控制Key words
Pancreaticoduodenectomy/ Pancreatic Neoplasms / Periampullary Carcinoma/ Postoerative Complication/ prev分类
医药卫生
