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目的探讨进展期胰头癌扩大根治加改良Whipple术式及介入灌注化疗的可行性,提高远期生存率和质量。方法剖腹探查93例,行扩大根治门静脉血管重建及改良Whipple术式(间置空肠Y形重建消化道)加人工乳头60例,其中合并门静脉(PV)部分切除24例、肝左叶及右叶肝段切除8例、横结肠中段切除3例。全组93例分治疗组、观察组和对照组:扩大根治加改良术式及术中经肝固有动脉和肠系膜上静脉灌注化疗,术后再经放射介入肠系膜上动脉及肝动脉灌注化疗(TACE)32例为治疗组;仅扩大根治加改良术式28例为观察组;姑息手术减黄改道33例为对照组。结果扩大根治切除率为64.5%(60/93),术后均无胆胰瘘、大出血,术后围手术期并发症死亡3例(并发重症肺炎于18d、30d死亡2例,31d急性肾功能衰竭死亡1例),至今生存5例(其中1例达13年)。治疗组和观察组术后1、2、3、4、5年生存率分别为93.7%、62.5%、40.6%、34.4%、25.0%和71.4%、42.8%、28.5%、21.4%、14.3%。对照组1年为24.2%、2～5年为0。三组的性别与年龄、生存率及死亡率经统计学处理(t检验、χ2检验):性别与年龄差异均无统计学意义(P>0.05),术后并发症、生存率及死亡率差异均有统计学意义(P<0.01)。结论扩大根治加改良术式及术中、术后介入灌注化疗治疗明显减少了术后并发症,提高了生存率和改善了远期生存质量。
Objective To investigate the feasibility of extended radical cure of advanced pancreatic head carcinoma with modified Whipple technique and interventional chemotherapy, and improve the long-term survival rate and quality. Methods A total of 93 cases underwent laparotomy for angioplasty and portal vein angioplasty. Sixty cases were treated with modified Whipple technique (Y-shaped reconstructive gastrointestinal jejunal reconstruction) with artificial nipple. 24 cases were partially resected with PV, and the left and right lobe of the liver Segmental hepatectomy in 8 cases, transverse colon resection in 3 cases. The whole group of 93 cases divided into treatment group, observation group and control group: extended radical plus modified surgery and intraoperative intrahepatic natural artery and superior mesenteric vein infusion chemotherapy, and then by radioactive interventional mesenteric artery and hepatic artery infusion chemotherapy (TACE ), 32 cases were treated group; only 28 cases were treated by modified radical mastectomy and modified operation group; 33 cases were treated by palliative operation by yellowing and redirecting as control group. Results The rate of radical resection was 64.5% (60/93). No postoperative cholangiopancreatic fistula and hemorrhage occurred. There were 3 cases of perioperative complications after operation (2 cases of severe pneumonia died on the 18th and 30th day, 31 cases of acute renal function 1 patient died of failure), 5 patients have survived so far (1 in 13 cases). The 1, 2, 3, 4, 5-year survival rates in the treatment and observation groups were 93.7%, 62.5%, 40.6%, 34.4%, 25.0% and 71.4%, 42.8%, 28.5%, 21.4% and 14.3% . The control group was 24.2% in 1 year and 0 in 2-5 years. Three groups of gender and age, survival and mortality were statistically analyzed (t test, χ2 test): gender and age were no significant difference (P> 0.05), postoperative complications, survival and mortality differences All were statistically significant (P <0.01). Conclusion Extended radical plus modified surgery and intraoperative and postoperative interventional chemotherapy significantly reduce postoperative complications, improve survival rate and improve long-term quality of life.