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目的探讨根治性胰十二指肠切除术在壶腹周围癌(AVC)中的临床治疗价值。方法回顾性分析我院1995年3月至2009年3月期间收治的195例AVC患者的临床资料,根据治疗方式分为非手术组(n=51)、姑息性手术组(n=96)和手术切除组(n=48).结果手术切除组术后1、3及5年生存率较姑息性手术组及非手术组明显提高(P<0.01),但手术切除组的并发症发生率较姑息性手术组和非手术组明显升高(P<0.05).外科治疗的不同部位肿瘤中,胰头癌患者根治切除率较胆总管末段癌及十二指肠乳头癌患者明显降低(P<0.01),并且胰头癌患者1、3及5年生存率也明显低于胆总管末段癌及十二指肠乳头癌患者(P<0.05,P<0.01).术前减黄治疗组与术前未减黄治疗组的围手术期并发症发生率、死亡率及1、3、5年生存率差异均无统计学意义(P>0.05).各组中年龄>70岁与≤70岁者的并发症发生率差异无统计学意义(P>0.05);但手术切除组年龄>70岁者的围手术期死亡率明显高于≤70岁者(P>0.05).结论外科手术切除仍然是治疗AVC的重要手段,尤其根治性胰十二指肠切除术是治疗壶腹周围癌的惟一有效方法,可以明显延长患者术后存活期,提高其生存质量。
Objective To investigate the clinical value of radical pancreatoduodenectomy in periampullary carcinoma (AVC). Methods The clinical data of 195 patients with AVC admitted to our hospital from March 1995 to March 2009 were retrospectively analyzed. According to the treatment, they were divided into non-operation group (n = 51), palliative operation group (n = 96) (N = 48) .Results The 1, 3 and 5 year survival rates of surgical resection group were significantly higher than those of palliative surgery group and non-surgical group (P <0.01), but the incidence of complications in surgical resection group Palliative surgery group and non-operation group was significantly higher (P <0.05) .Surgical treatment of different parts of the tumor, the radical resection rate of pancreatic cancer in patients with end-stage bile duct cancer and duodenal papillary carcinoma was significantly lower (P <0.01), and the 1,3 and 5-year survival rates of patients with pancreatic head cancer were significantly lower than those with end-stage bile duct carcinoma and duodenal papillary carcinoma (P <0.05, P <0.01) There was no significant difference in perioperative complication rate, mortality rate and 1,3 and 5 year survival rate between the two groups (P> 0.05) There was no significant difference in the complication rates between the two groups (P> 0.05). However, the perioperative mortality rate of the 70-year-old group was significantly higher than that of the 70-year-old group (P> 0.05) Resection is still an important means of treatment of AVC, especially radical pancreaticoduodenectomy is the only effective treatment for periampullary can significantly prolong survival in patients after surgery, to improve their quality of life.