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目的:探讨胰头癌的外科治疗.方法:因术前临床诊断胰头癌施行胰十二指肠切除术265例,其中行常规胰十二指肠切除术(WhiPPle)152例,保留幽门型胰十二指肠切除术(PPPD)75例,包括切除一段血管的胰十二指肠切除术19例,经再次手术行胰十二指肠切除术17例,全胰切除术2例.术前经B超、CT、选择性ERCP、穿刺细胞学检查,确诊232例(87.5%).术后经病理证实:胰头癌132例,壶腹癌77例,胆总管远端癌22例,十二指肠癌16例,转移癌1例和良性病变17例(慢性胰腺炎14例和良性肿瘤3例).结果:术后发生并发症118例(47.6%),住院死亡10例(4%).PPPD术后并发胃排空障碍较其它术式显著增高(P<0.01).结论:由非胰腺专业组医师施行的手术死亡率明显高于专业组医师(P<0.05),只要病例选择恰当,围手术期良好的处理,可以继续降低手术死亡率.
Objective: To investigate the surgical treatment of pancreatic head cancer. Methods: 265 patients undergoing pancreatoduodenectomy for preoperative clinical diagnosis of pancreatoduodenitis, of whom 152 were treated with conventional pancreatoduodenectomy (WhiPPle) and preserved pyloric Pancreaticoduodenectomy (PPPD) in 75 cases, including 19 cases of resection of a pancreatoduodenectomy, 17 cases of pancreaticoduodenectomy after reoperation, and 2 cases of total pancreatectomy. Before B-ultrasound, CT, selective ERCP, and aspiration cytology, 232 cases (87.5%) were diagnosed. Pathologically confirmed: 132 cases of pancreatic cancer, 77 cases of ampullary carcinoma, and 22 cases of distal common bile duct cancer. There were 16 cases of duodenal cancer, 1 case of metastatic carcinoma and 17 cases of benign lesions (14 cases of chronic pancreatitis and 3 cases of benign tumors). Results: 118 cases (47.6%) of postoperative complications and 10 cases of hospital deaths (4 cases) (2).Patients with gastric emptying after PPPD were significantly higher than other surgical methods (P<0.01). Conclusion: The mortality rate of non-pancreas professional group doctors was significantly higher than that of professional group physicians (P<0.05). Choosing appropriate, perioperative, and good treatment can continue to reduce operative mortality.