目的提高胰头及壶腹周围病变的切除率，降低术后并发症发生率及病死率。方法将连续收治的２８１例胰头及壶腹周围病变按年份分为前组１４１例和后组１４０，分析比较二组的疗效。结果前组切除３６例（２５．５％），后组切除７１例（５０．７％），后组明显高于前组。后组的并发症和病死率为２６．８％和２．８％，明显低于前组的５８．３％和１１．１％。结论早期诊断、细致解剖、切除前不一定追究病理诊断和扩大手术适应证，能提高手术切除率。充分的术前准备、熟练的手技和手术组密切配合、优选良好的径路和术式以及术后密切监护能降低手术并发症和病死率。 Objective To improve the resection rate of pancreatic head and periampullary lesions and reduce the incidence of postoperative complications and mortality. Methods 281 cases of continuous pancreatic head and periampullary lesions were divided into 141 cases in the previous group and 140 in the posterior group. The efficacy of the two groups was analyzed and compared. Results 36 cases (25.5%) were excised in the former group and 71 cases (50.7%) in the posterior group. The latter group was significantly higher than the former group. The complications and mortality of the latter group were 26.8% and 2.8%, which were significantly lower than those of the former group (58.3% and 11.1%). Conclusions Early diagnosis, detailed anatomy, resection before excision are not necessarily pursued pathological diagnosis and expansion of surgical indications, can improve the surgical resection rate. Adequate preoperative preparation, close coordination with skilled hand-craftsmanship and surgery groups, preferred good pathways and surgical procedures, and close monitoring after surgery can reduce surgical complications and mortality.