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近代许多报告指出,对可切除的壶腹周围恶性肿瘤,提倡作姑息性手术治疗,放弃根治性的胰十二指肠切除术。作者根据所在医院32年中53例胰十二指肠切除术的经验和结果,就下述三方面阐述不同的观点。 1.存活期和手术死亡率:1970年,Crile报告了Cleveland医院胰腺癌的手术治疗结果,显示姑息性转流术的存活期长于根治性胰十二指肠切除术。同年他们再次报告,对壶腹周围的其他癌肿,手术治疗结果亦如此,而且手术死亡率为20%。因此他们提出,对这些癌肿应该采用姑息性的转流术,而胰十二指肠切除术仅限于65岁以下的,全身情况良好的乳头状或息肉状肿瘤病人。本组对可切除的胰和壶腹周围恶性肿瘤以2.5和10年为界,统计根治性胰十二指肠切除
Many reports in modern times point out that for resectable periampullary malignant tumors, palliative surgery is advocated and radical pancreatoduodenectomy is abandoned. Based on the experiences and results of 53 cases of pancreatoduodenectomy performed in the 32 years of the hospital, the author elaborates on the following three aspects. 1. Survival and operative mortality: In 1970, Crile reported surgical treatment of pancreatic cancer at Cleveland Hospital, showing that palliative bypass surgery survived longer than radical pancreatoduodenectomy. In the same year, they reported again that the surgical treatment results for other cancers around the ampulla were also the same, and the operative mortality rate was 20%. Therefore, they proposed that palliative bypass surgery should be used for these cancers, and pancreatoduodenectomy is limited to patients under the age of 65 who have good systemic papillary or polypoid tumors. This group of patients with resectable pancreatic and periampullary malignancies at the boundary of 2.5 and 10 years, statistical radical pancreatoduodenectomy