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了解胰十二指肠切除术治疗胰头和壶腹部癌的效果和影响病人生存的因素。方法:分析230例胰头和壶腹部癌的主要表现,辅助检查、手术并发症、手术死亡率,调查术后生存情况及影响病人长期生存的因素。结果:本组病人出现黄疽90.9％,腹痛56.1％,发热32.6％,白陶土样大便13.5％。B超、CT和ERCP检查准确率分别为68.3％、79.3％和66.6％。手术并发症72例(31.3％),死亡20例(8.7％)。术后1、3、5年存活率分别为46.7％,17.4％和52％。肿瘤直径、淋巴结转移和切缘状态是影响病人术后生存的因素,而肿瘤分化程度和病人年龄对生存率无明显影响。结论:胰头和壶腹部癌临床表现有多样性,B超和CT等辅助检查有局限性,手术有高并发症,5年生存率低下,手术治疗远近期效果都不理想。
To understand the effect of pancreatoduodenectomy on cancer of the pancreatic head and ampulla and the factors affecting patient survival. METHODS: The main manifestations of 230 cases of pancreatic head and ampullary carcinoma were analyzed, including auxiliary examination, surgical complications, and operative mortality rate. The survival situation after surgery and the factors influencing the long-term survival of the patients were analyzed. Results: In this group of patients, there were 90.9% of jaundice, 56.1% of abdominal pain, 32.6% of fever, and 13.5% of white clay-like stool. The accuracy of B-ultrasonography, CT, and ERCP examinations was 68.3%, 79.3%, and 66.6%, respectively. Surgical complications occurred in 72 patients (31.3%) and 20 deaths (8.7%). The survival rates at 1, 3, and 5 years after surgery were 46.7%, 17.4%, and 52%, respectively. Tumor diameter, lymph node metastasis, and margin status were factors that affected the patient’s postoperative survival. The degree of tumor differentiation and patient age had no significant effect on survival. Conclusion: The clinical manifestations of pancreatic head and ampullary carcinoma are diversified. The auxiliary examinations such as B-ultrasonography and CT have limitations. The surgery has high complications and the 5-year survival rate is low. The surgical treatment is far from satisfactory.