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目的 用回顾性方法研究近 30年胰腺癌行根治性胰十二指肠切除术的相关因素 ,探讨手术及肿瘤的性状与生存的关系。方法 华山医院 1970～ 1999年收治的 377例行手术治疗的胰腺癌病人 ,其中 75例行Whipple手术或区域性胰十二指肠切除术 (包括 10例介入治疗后再手术切除病例 )。结果 手术切除率从 70年代的 9%提高到 90年代的 2 8 2 %。区域性胰十二指肠切除术 ,包括淋巴结廓清 ,对累及门静脉和肠系膜上静脉的病例行静脉切除及搭桥术 ,也增加了手术的切除率及生存率。手术后 1,3,5年的生存率在 70年代分别为 5 0 % ,2 5 %和 0 % ,80年代为 5 7 1% ,2 8 5 %和 9% ,90年代为 6 1 6 % ,2 7%和 11 1%。结论 胰头癌病人的长期生存与肿瘤的大小 ,淋巴结转移和神经丛的浸润有关 ,因而提出在掌握标准的Whipple(DP)技术后可以做广泛的淋巴结和软组织清除 ,清扫范围达腹主动脉旁 (EP) ,必要时可采用区域性胰腺切除 (RP) ,以期提高胰头癌的长期生存质量
Objective To retrospectively study the related factors of radical pancreaticoduodenectomy for pancreatic cancer in recent 30 years, and to explore the relationship between the operative and tumor traits and survival. METHODS: 377 surgically treated patients with pancreatic cancer were treated in Huashan Hospital from 1970 to 1999. Of these patients, 75 received Whipple surgery or regional pancreatoduodenectomy (including 10 cases after interventional surgery). Results The surgical resection rate increased from 9% in the 1970s to 282% in the 1990s. Regional pancreatoduodenectomy, including clearance of lymph nodes, and phlebectomy and bypass surgery involving the portal vein and superior mesenteric veins, also increased the surgical resection rate and survival rate. The survival rates at 1, 3, and 5 years after surgery were 50%, 25%, and 0% in the 1970s, 57.1%, 2.85%, and 9% in the 1980s, and 61.6% in the 1990s. , 27% and 11 1%. Conclusions The long-term survival of patients with pancreatic head cancer is related to tumor size, lymph node metastasis, and infiltration of nerve plexus. Therefore, it is proposed that extensive removal of lymph nodes and soft tissues can be performed after mastering the standard Whipple (DP) technique. (EP) Regional pancreatectomy (RP) may be used if necessary to improve long-term survival of pancreatic cancer