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胰头十二指肠切除术,自Whipple报告十二指肠乳头癌根治术成功病例以来,已能进行胰头部范围癌根治术。过去,因手术死亡率及术后并发症发生率较高,术后远期效果不好,故也有否定该术式的报告。但最近随着手术死亡率、术后并发症发生率的降低,而有术后远期生存率也比以前增高的报告。另外,胰头十二指肠切除术适应证的胰头癌、乳头癌、下部胆管癌、十二指肠癌,其预后有很大差别。本文就有关决定胰头十二指肠切除术的预后的因素进行叙述。1.胰头癌据全国统计,胰腺癌切除2102例中,5年存活率为17.4%,即便是胰腺癌中最多的普通型胰管癌,几乎全部病例均可见到淋巴管、血管或神经的浸润,淋巴结转移和后腹膜神经丛浸润发生率尤高,切除病例多数在手术时已为进行性胰腺癌。即使是小胰腺
The pancreatic head and duodenal resection, since Whipple reported a successful case of radical resection of duodenal papilloma carcinoma, has been able to carry out radical pancreatic head cancer surgery. In the past, because of the high mortality rate and postoperative complications, the postoperative long-term effect was not good. Therefore, there was also a negative report on this procedure. However, recently, with the reduction of operative mortality and the incidence of postoperative complications, there has been a report that the postoperative long-term survival rate is higher than before. In addition, the prognosis of pancreatic head cancer, papillary cancer, lower bile duct cancer, and duodenal cancer is very different in the indications for pancreatoduodenectomy. This article describes the factors that determine the prognosis of pancreaticoduodenectomy. 1. Pancreatic head cancer According to the national statistics, the 5-year survival rate was 17.4% in 2,102 cases of pancreatic cancer resection. Even the most common type of pancreatic cancer in pancreatic cancer, almost all cases can be seen in lymphatic vessels, blood vessels, or nerves. The incidence of infiltration, lymph node metastasis, and retroperitoneal plexus infiltration was particularly high. Most of the resection cases were progressive pancreatic cancer at the time of surgery. Even small pancreas