论文部分内容阅读
目的:探讨一期未能切除的老年壶腹周围恶性肿瘤患者和结肠癌根治切除术后胰头区转移癌患者行胰十二指肠切除术的可行性和手术特点.方法:4例恶性梗阻性黄疸患者中,2例一期手术施行胆囊切除术、胆总管探查术、T型管引流术,另2例一期手术施行胆管空肠吻合术,待黄疸减退、肝功能好转后,二期手术施行胰十二指肠切除术.1例结肠癌根治术后19年再次发现乙状结肠癌及胰头区转移癌,随后同时成功实施胰十二指肠切除术及乙状结肠癌根治术.分析患者生存情况.结果:5例患者中,有1例胆总管引流近2mo后在外院拔除T管,拔管后出现黄疸及胆管炎表现,逐渐加重,再次来我院就诊后很快实施了胰十二指肠切除术,术后10d死于肝肾功能衰竭.其余4例术后逐渐康复,术后定期化疗,分别生存32、41、58、79mo,其中存活58mo的1例患者目前仍健康存活.结论:一期未能切除的老年壶腹周围恶性肿瘤患者及结肠癌根治切除术后胰头区转移癌患者,行胰十二指肠切除术仍能显著延长患者生命,改善生活质量.
Objective: To investigate the feasibility and operative characteristics of pancreaticoduodenectomy in patients with malignant tumor of the ampulla of the elderly who have not been resected and patients with metastatic carcinoma of the pancreas in the head of colon after radical resection of colon.Methods: Four cases of malignant obstruction Among the patients with jaundice, 2 cases underwent cholecystectomy, common bile duct exploration and T-tube drainage in the first stage, while the other 2 cases underwent choledochojejunostomy in the first stage. After the jaundice decreased and the liver function improved, the second stage operation Performed pancreatoduodenectomy.One case of colon cancer after radical resection 19 years again found metastatic sigmoid colon and pancreatic head cancer, followed by the successful implementation of pancreatoduodenectomy and radical resection of sigmoid colon.Analysis of patient survival .Results: Among the 5 patients, one case of common bile duct drainage in the second hospital after removal of T tube, jaundice and cholangitis after extubation performance, and gradually increased, once again come to our hospital after the implementation of pancreatic twelve Bowel resection and died of liver and kidney failure 10 days after operation.The remaining 4 patients recovered gradually after operation and received regular chemotherapy after operation for 32, 41, 58 and 79 months respectively, of which 1 patient surviving for 58 months still survived healthily. : A failed amputation of the elderly ampulla Peripheral malignant tumor patients and patients with metastatic carcinoma of the pancreas in the pancreas after radical resection of the colon cancer can still significantly prolong their life and improve their quality of life after pancreatoduodenectomy.