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目的对壶腹周围癌手术中右侧腹腔神经节清扫的方法、意义、疗效等进行探讨。方法对自2001年起收治的43例胰十二指肠切除术和20例短路手术中行右侧腹腔神经节清扫的时间、风险、方法、疗效和术后随访等进行回顾性分析。结果63例右侧腹腔神经节清扫平均耗时(16·4±2·4)min,出血(13·5±6·5)mL,没有出现明显的术中和术后并发症;胰十二指肠切除组中,病理证实25例(58·14%)有神经侵犯,术后18个月以后复发的40例中37例(92·5%)无明显腹痛;短路组中病理证实为神经组织者均有神经侵犯,生存者中10例(50%)无腹痛,腹痛能够忍受4例,腹痛不能忍受6例。结论壶腹周围癌的根治手术和短路手术中均应常规切除右侧腹腔神经节,既有助于肿瘤的根治,也有利于预防肿瘤复发引起的腹痛。
Objective To investigate the method, significance and curative effect of right celiac ganglia dissection in peri-ampullary carcinoma. Methods Retrospective analysis was performed on the time, risk, method, efficacy and postoperative follow-up of 43 cases of pancreatoduodenectomy and 20 cases of short-circuit surgery undergoing right celiac ganglion since 2001. Results The right side of the celiac ganglion in 63 patients took an average of (16.4 ± 2.4) min and hemorrhage (13.5 ± 6.5) mL, and no obvious intraoperative and postoperative complications occurred. In the nidus resection group, 25 cases (58.14%) had neurological invasion confirmed by pathology, and 37 cases (92.5%) had no abdominal pain in 40 cases relapsed 18 months after operation. The pathological findings in the short-circuit group were nerve Organizers had neurological violations, 10 (50%) survivors without abdominal pain, abdominal pain can tolerate 4 cases, abdominal pain can not stand in 6 cases. Conclusion Periampullary carcinoma of the radical operation and short-circuit surgery should be routine removal of the right celiac ganglion, both to help cure the tumor, but also help prevent recurrence of abdominal pain caused by the tumor.