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本文报告1962～1982年216例胰腺及壶腹区癌肿外科治疗的结果。第一阶段(1962～1977年)114例,第二阶段(1978～1982年)102例。早期病例(Hermreck Ⅰ期)在一、二阶段分别为8.8%及19.6%;胰头癌手术切除率分别为25.6%及37.7%;其1年生存率分别为50%及61%,3年生存率为8.3%及15.3%,5年生存率为0%及11.1%。各阶段效果进展的原因有:①成立专题门诊及病房,对可疑病例及时作有关检查。②手术中对怀疑病例主张作楔形活检,必要时切开十二指肠或Oddi括约肌检查。第一阶段手术误诊率为8.8%,而第二阶段无误诊。③第二阶段对黄疸较深者作分期手术30例。一期手术死亡率为21%,并发症为57.8%,分期手术死亡率为10%,并发症为30%。④手术方式采取扩大的区域性胰十二指肠切除术,清除胰腺,第一、二站的淋巴结及脂肪结缔组织,必要时作门静脉或肠系膜上静脉切除移植或吻合术。
This article reports the results of surgical treatment of 216 pancreatic and ampulla area cancers from 1962 to 1982. There were 114 cases in the first phase (1962-1977) and 102 cases in the second phase (1978-1982). The early cases (Hermreck I) were 8.8% and 19.6% in the first and second phases, respectively; the resection rates of pancreatic head cancer were 25.6% and 37.7%, respectively; the 1-year survival rates were 50% and 61%, respectively, and the survival rate was 3 years. The rate was 8.3% and 15.3%. The 5-year survival rate was 0% and 11.1%. The reasons for the progress of the various stages are as follows: (1) The establishment of special outpatient clinics and wards for the timely examination of suspicious cases. 2 Wedge biopsies were performed on suspected cases during surgery and duodenal or Oddi sphincterotomy was performed if necessary. The misdiagnosis rate in the first stage was 8.8%, while the second stage was not misdiagnosed. 3 In the second stage, 30 patients with deeper jaundice were operated on by stages. The mortality rate in the first-stage operation was 21%, the complication rate was 57.8%, the stage-operation mortality rate was 10%, and the complication rate was 30%. 4 surgical approach to take an extensive regional pancreaticoduodenectomy, removal of the pancreas, the first two stations of lymph nodes and adipose connective tissue, if necessary, for the portal vein or superior mesenteric vein resection or anastomosis.