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目的 总结近年来新的诊断和治疗技术对壶腹周围癌外科手术疗效的影响。方法 回顾性分析 195 8～ 1976年、1977～ 1987年、1988～ 1998年 3个时间段的壶腹周围癌 345例在我院的手术治疗情况。结果 195 8～ 1976年的 12 8例中 ,胰头癌、壶腹癌、胆管下端癌及十二指肠癌所占比例分别为 6 1 7%、2 2 6 %、10 2 %及 5 5 % ,切除率分别为 2 7%、86 %、38%及 5 7% (4 / 7) ;1977～ 1987年的70例中 ,胰头癌、壶腹癌、胆管下端癌及十二指肠癌所占比例分别为 85 7%、8 6 %、1 4%及 4 3% ,胰头癌切除率为 2 7% ;1988～ 1998年的 147例中 ,胰头癌、壶腹癌、胆管下端癌及十二指肠乳头癌所占比例分别为 74 2 %、10 9%、2 7%及 12 2 % ,胰头癌切除率为 2 0 %。 1977～ 1998年壶腹癌的切除率为73 % ,胆管下端癌为 6 0 % (3/ 5 ) ,十二指肠乳头癌为 6 7%。未能切除病例多采用胆囊十二指肠吻合术。195 8～ 1976年胰十二指肠切除术的 5 5例中 1年存活率为 6 4%、3年为 38%、5年为 2 5 % ;1977～ 1987年胰十二指肠切除术的 2 3例中 ,1年存活率为 6 5 %、3年为 43 %、5年为 30 %。总并发症发生率 :195 8～1976年为 38%、1977～ 1998年为 2 5 %。 195 8～ 1976年手术死亡率为 18% ,原因依次为肝肾功能衰竭 ,胰瘘 ,?
Objective To summarize the effects of new diagnostic and therapeutic techniques on the efficacy of surgical treatment of periampullary carcinoma in recent years. Methods We retrospectively analyzed 345 cases of periampullary cancer in three periods from 195 to 1976, 1977 to 1987, and 1988 to 1998 in our hospital. RESULTS Among the 128 cases from 198 to 1976, the proportions of pancreatic head cancer, ampullary cancer, lower bile duct cancer, and duodenal cancer were 61.7%, 2.26%, 102%, and 55%, respectively. % The resection rate was 27%, 86%, 38%, and 57% (4 / 7), respectively; from the 1977 to 1987, 70 cases of pancreatic cancer, ampullary carcinoma, lower bile duct carcinoma, and duodenum The proportions of cancers were 85 7%, 8 6%, 1 4%, and 4 3%, respectively, and the resection rate of pancreatic head cancer was 27%. Among 147 cases from 1988 to 1998, pancreatic cancer, ampullary cancer, and bile duct The proportions of lower cancer and duodenal papillary cancer were 74 2%, 109%, 27% and 12%, respectively, and the resection rate of pancreatic cancer was 20%. From 1977 to 1998, the resection rate of ampullary carcinoma was 73%, the lower biliary carcinoma was 60% (3/5), and the duodenal papillary carcinoma was 67%. The gallbladder duodenal anastomosis was often used for cases that failed to be removed. The 5-year survival rate of pancreaticoduodenectomy from 195 to 1976 was 64%, 38% at 3 years, and 25% at 5 years; Pancreatoduodenectomy from 1977 to 1987 Of the 23 patients, the 1-year survival rate was 65 percent, 43 percent in 3 years, and 30 percent in 5 years. The incidence of total complications was 38% from 195 to 1976 and 25% from 1977 to 1998. 195 8 ~ 1976 surgical mortality rate was 18%, followed by liver and kidney failure, pancreatic fistula,?