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本文分析麻省总医院(MGH)新近胰头癌切除病人的失败类型,着重研究其手术切除缘。1978～1991年在MGH共计切除胰头癌72例。女33例,男39例,平均年龄61岁(31～81岁)。外科手术包括59例标准胰十二指肠切除术,8例保留幽门胰十二指肠切除术,5例全胰切除,术前检查或手术时未发现转移病灶。67例(93%)做了病理标本检查,其中37例(51%)切缘有肿瘤侵犯,计胰周软组织(27例次)、胰横断面(14例次)、胆管横断面(4例次),胃或十二指肠切除面无肿瘤侵犯。全组72例切除病人中,39例术后接受放疗,剂量40Gy～50Gy,分22～28次,每次1.8Gy,持续5～6周,在放疗的头一周和末一周病人连续静脉注射5Fu(500mg/m~2。d,3天)。全组的5年存活率、局部控制和远处转移率分别
This article analyzes the type of failure in patients with recent resection of pancreatic head cancer in the General Hospital of Massachusetts (MGH) and focuses on the surgical resection margin. From 1978 to 1991, 72 cases of pancreatic head cancer were resected in MGH. There were 33 females and 39 males with an average age of 61 years (31-81 years old). Surgical procedures included 59 cases of standard pancreaticoduodenectomy, 8 cases of pylorus and pancreatoduodenectomy, 5 cases of pancreatic resection, and no metastatic lesions were found during preoperative examination or surgery. Sixty-seven patients (93%) underwent pathological examination. Among them, 37 (51%) had tumor invasion at the margin, peripancreatic soft tissue (27 cases), pancreatic cross-section (14 cases), and bile duct cross-section (4 cases). Secondly, there was no tumor invasion in the stomach or duodenal resection. Among the 72 patients in the entire group, 39 received postoperative radiotherapy at doses of 40 Gy to 50 Gy, 22 to 28 times, 1.8 Gy each for 5 to 6 weeks. In the first week and last week of radiotherapy, patients received continuous intravenous injection of 5 Fu. (500 mg/m~2 d, 3 days). The 5-year survival rate, local control, and distant metastasis rate of the whole group were