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目的探讨联合腹腔干切除的胰体尾癌切除术(DP-CAR,也称改良Appleby手术)在治疗进展期胰体尾癌的安全性。方法收集2012年至2014年在新疆医科大学第一附属医院胰腺外科进行的9例改良Appleby手术患者的临床资料,以及同一时间段内11例行标准胰体尾切除术(DP)患者的临床资料,进行对比分析。分别从手术时间,术中出血量、术后并发症(胰瘘,腹泻,胃缺血,肝功能不全)及术后住院天数等研究因素,分析两种手术方式组间观察指标是否有统计学差异,旨在探讨改良Appleby手术的安全性。结果两种手术方式除术后患者肝功能不全有统计学差异外(P<0.05),在平均手术时间,术后平均住院天数上具有统计学差异(P<0.05),在平均术中出血量,术后并发症(肝功能异常除外),术后通气时间,术后患者疼痛缓解率及术后死亡率之间无统计学差异(P>0.05);在改良Appleby手术组,天冬门氨酸氨基转移酶(AST)和丙氨酸氨基转移酶(ALT)术后第一天开始升高,在第二天出现一个高峰,AST平均峰值为464.59U/L,ALT平均峰值为325.84U/L,两者均在第三天开始下降,随后逐渐平稳,最终恢复正常范围。结论对局部进展期胰体尾癌,改良Appleby手术是安全的,能够提高胰体尾癌的手术切除率而不增加手术死亡率。
Objective To investigate the safety of combined pancreatic body cancer resection (DP-CAR, also known as modified Appleby operation) in the treatment of advanced pancreatic body cancer. Methods The clinical data of 9 patients with modified Appleby who underwent pancreatic surgery at the First Affiliated Hospital of Xinjiang Medical University from 2012 to 2014 and clinical data of 11 patients undergoing standard pancreaticoduodenectomy (DP) during the same period were collected. , For comparative analysis. Respectively from the operation time, intraoperative blood loss, postoperative complications (pancreatic fistula, diarrhea, gastric ischemia, liver insufficiency) and postoperative hospital days and other research factors, analysis of the two surgical methods between groups were statistically significant The difference is to explore the safety of modified Appleby surgery. Results There was significant difference (P <0.05) between the two operation modes except the postoperative liver dysfunction (P <0.05), the average operation time and average length of postoperative hospital stay (P <0.05), mean intraoperative blood loss , Postoperative complications (except liver dysfunction), postoperative ventilation time, postoperative pain relief rate and postoperative mortality were not statistically different (P> 0.05). In the modified Appleby operation group, aspartame Acid aminotransferase (AST) and alanine aminotransferase (ALT) began to rise on the first postoperative day, with a peak on the next day, with an average peak AST of 464.59U / L and an average peak ALT of 325.84U / L, both began to decline on the third day, then gradually stabilized and eventually returned to normal range. Conclusion It is safe for locally advanced pancreatic body endocarcinoma and modified Appleby operation, which can improve the surgical resection rate of pancreatic body and tail cancer without increasing the operative mortality rate.