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目的探讨胃幽门窦癌浸润胰头时的手术方法。方法回顾性分析1984年6月至2004年6月收治的采用胰十二指肠切除术(PD)治疗的胃癌侵及胰头43例临床资料。结果无手术死亡。19例根治手术中联合胰十二指肠切除术15例,胰头局部切除4例;姑息切除17例;探查及胃空肠吻合7例。术后并发症发生率:PD术后为33%(5/15),胰头部分切除为25%(1/4),姑息切除为18%(3/17),探查活检为14%(1/7)。组间差异无显著性意义(P>0·05)。随访:中位生存时间PD为26个月(12~156个月),胰头部分切除为23个月(14~73个月),姑息切除为8个月(3~37个月),探查及胃空肠吻合为3个月(1·5~9·0个月)。联合PD和胰头部分切除的生存期明显长于姑息切除和探查及胃空肠吻合组(P<0·01)。结论胃幽门窦癌联合PD或胰头局部切除能够提高病人的生存期,手术指征选择恰当和肿瘤的彻底根治是取得良好临床效果的关键。
Objective To investigate the surgical method of gastric pyloric sinus cancer infiltration of the head of pancreas. Methods The clinical data of 43 cases of gastric cancer invading the head of pancreas treated with pancreaticoduodenectomy (PD) from June 1984 to June 2004 were retrospectively analyzed. The result was no operative death. 19 cases of radical surgery combined with pancreatoduodenectomy in 15 cases, pancreatic head partial resection in 4 cases; palliative resection in 17 cases; exploration and gastrojejunostomy in 7 cases. The incidence of postoperative complications was 33% (5/15) after PD, 25% (1/4) for partial pancreatic head resection, 18% (3/17) for palliative resection and 14% for probing biopsy / 7). No significant difference between groups (P> 0.05). Follow-up: The median survival time (PD) was 26 months (range, 12 to 156 months), partial pancreatic resection for 23 months (14 to 73 months), palliative resection for 8 months (3-37 months) And gastrojejunostomy for 3 months (1.5-9.0 months). Combined PD and partial pancreatic resection had significantly longer survival than palliative resection and exploration of jejunostomy (P <0.01). Conclusions Gastric pyloric sinus cancer combined with PD or pancreatic head excision can improve the survival of patients. Proper surgical indications and complete radical cure of tumor are the keys to achieve good clinical results.