目的 探讨螺旋CT双期薄层增强扫描对胰头癌可切除性的评估价值。方法 回顾性分析24例经螺旋CT双期薄层增强扫描胰头癌的CT表现，观察肿块对邻近器官或组织侵犯情况，以及有无远处器官和淋巴结转移，据此判断肿块能否切除，并将其结果与手术病理结果相对照。结果 螺旋CT判断胰头癌可切除的敏感性为90.9%，特异性为84.6%，阳性预测值为83.3%，阴性预测值为91.7%，准确性为87.5%。结论 螺旋CT双期薄层增强扫描判断胰头癌可切除性的价值较高，对外科医生选择最佳治疗方案有较大的帮助。
ObjectiveTo compare surgical safety and postoperative efficacy of total mesopancreas excision (TMpE) with pancreaticoduodenectomy (PD) and standard PD (Whipple).MethodsA total of 123 patients underwent PD in the Affiliated Hospital of Southwest Medical University from August 2013 to December 2017 were included, including 47 patients with pancreatic head carcinoma and 76 patients with periampullary carcinoma, then were divided into a TMpE group and a Whipple group respectively. The operative time, intraoperative blood loss, postoperative hospitalization time, postoperative recovery time of gastrointestinal function, postoperative complications, and postoperative survival of patients with the same site between the Whipple group and the TMpE group were retrospectively compared.Results① There were no significant differences in the baseline data between the TMpE group and the Whipple group in the pancreatic head carcinoma and periampullary carcinoma (P>0.05). ② For the patients with pancreatic head carcinoma, there were no significant differences in the operative time, postoperative hospitalization time, and postoperative gastrointestinal function recovery time between the TMpE group and the Whipple group (P>0.05), but the intraoperative blood loss in the TMpE group was significantly higher than that in the Whipple group (P=0.038); For the patients with periampullary carcinoma, the above indexes had no significant differences between the TMpE group and the Whipple group (P>0.05). ③ The total incidence of complications in the TMpE group was significantly higher than that in the Whipple group for the patients with pancreatic head carcinoma (χ2=6.595, P=0.010), which had no significant difference between the TMpE group and the Whipple group for the patients with periampullary carcinoma (P>0.05). ④ The cumulative survival curve in the TMpE group was better than that in the Whipple group for the patients with pancreatic head carcinoma (χ2=9.597, P=0.002), which had no significant difference between the TMpE group and the Whipple group for the patients with periampullary carcinoma (χ2=0.844, P=0.358).ConclusionsFor patients with pancreatic head cancer, comparing with standard Whipple, although TMpE PD increases intraoperative blood loss and overall incidence of complications, it could significantly improve long-term survival and there are no significant differences in postoperative recovery time and operative safety between Whipple and TMpE; For patients with periampullary carcinoma, there are no significant differences in surgical safety, long-term survival rate, and survival time between TMpE and Whipple.
ObjectiveTo compare the efficacy between laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in treatment of carcinoma of head of pancreas. MethodsClinical data of 60 patients with locally advanced carcinoma of head of pancreas who underwent pancreaticoduodenectomy in our hospital from October 2004 to October 2009 were collected, of which 26 patients were in LPD group and 34 patients were in OPD group. ResultsOperative time and hospitalization expense of patients in LPD group were both longer or more than those of OPD group (P<0.05), but blood loss, time of starting activity, time of aeration, time of pulling out the drainage tube, time of pulling out the stomach tube, time of absolute resting on bed, and hospitalization time in LPD group were all shorter or lower than those of OPD group (P<0.05). There were 25 patients suffered with postoperative complications, including 10 patients in LPD group and 15 patients in OPD group, and there was no significant difference between the 2 groups in total incidence of postoperative complication (P>0.05). But in the specific postoperative complication, the incidences of pancreatic fistula and biliary fistula of LPD group were higher than those of OPD group (P<0.05), but incidences of incision infection, pulmonary infection, and systemic infection were all lower than those of OPD group (P<0.05). All patients were followed up for 1-60 months with the median time of 21.5 months. During the follow-up period, in LPD group, 24 patients suffered with recurrence, 20 patients suffered with tumor metastasis, and 24 patients died; in LPD group, 31 patients suffered with recurrence, 25 patients suffered with tumor metastasis, and 31 patients died. There were no significant difference between the 2 groups in the recurrence rate, metastasis rate, mortality, and survival situation (P>0.05). ConclusionsFor carcinoma of head of pancreas, postoperative recovery and infection complications of LPD are significantly superior than those of OPD. But compared with the OPD, it has no obvious advantage in reducing the pancreatic fistula, biliary fistula, delayed gastric emptying, and other complications, and it also has no obvious advantage in improving the long-term survival situation too.
ObjectiveTo explore value of preoperative neutrophil-to-lymphocyte ratio (NLR) combined with carbohydrate antigen 19-9 (CA19-9) in evaluating prognosis for patients with pancreatic head carcinoma.MethodsThe clinical data of patients with pancreatic head carcinoma underwent radical pancreaticoduodenectomy in the Lanzhou University Second Hospital from February 2011 to August 2017 were retrospectively analyzed. The preoperative serum albumin (ALB), CA19-9, NLR, carcino-embryonic antigen (CEA), alpha-fetoprotein (AFP), N stage, tumor differentiated degree, and other indicators were recorded and the patient’s overall survival was recorded. Linear correlation analysis was used to examine the association of NLR with serum CA19-9. The receiver operating characteristic (ROC) curve was used to calculate the cutoff values of NLR and CA19-9 corresponding to the overall survival rate of 2-year. Kaplan-Meier method was used for survival analysis. Cox proportional hazards regression model was used to evaluate the prognostic value of preoperative CA19-9 and NLR.Results① A total of 121 patients were enrolled in this study. There was no significant correlation between the preoperative serum CA19-9 and NLR (r=0.100 05, P=0.272 9). ② Multivariate analysis showed that higher NLR, higher CA19-9 level, higher N stage, and lower tumor differentiation were the risk factors for overall survival of pancreatic head carcinoma (P<0.05). ③ The cutoff values of CA19-9 and NLR in evaluating the 2-year overall survival rate were 123.3 U/mL and 2.34 respectively by the ROC curve analysis, the area under ROC curve of CA19-9, NLR, and CA19-9 combined with NLR were 0.763, 0.686, and 0.823, respectively. ④ The proportions of patients with CEA≥5 μg/L and ≥N1 stage were higher in the patients with CA19-9≥123.3 U/mL as compared with patients with CA19-9<123.3 U/mL (P<0.05); The proportions of patients with preoperative serum ALB level <35 g/L and CEA≥5 μg/L, ≥N1 stage, and poor differentiation were higher in the patients with NLR≥2.34 as compared with the patients with NLR<2.34 (P<0.05). ⑤ Kaplan-Meier survival analysis showed that patients with CA19-9≥123.3 U/mL and NLR≥2.34 had worse overall survival than those patients with CA19-9<123.3 U/mL and NLR<2.34 (HR=3.599, P<0.01; HR=2.506, P<0.01). The patients with CA19-9≥123.3 U/mL and NLR≥2.34 (n=42), CA19-9≥123.3 U/mL or NLR≥2.34 (n=48), CA19-9<123.3 U/mL and NLR<2.34 (n=31) had better overall survival in turn (overall and between groups, all P<0.01).ConclusionPreoperative serum CA19-9 combined with NLR has an important value in evaluating prognosis for patients with pancreatic head carcinoma.
【摘要】目的探讨提高可切除胰头癌疗效和降低手术风险的方法。方法回顾我院1996年1月至2001年12月期间行根治性胰十二指肠切除术治疗的胰头癌病例，对可切除胰头癌患者的术前评估、围手术期治疗和术式选择进行分析。结果外科收治胰头癌271例，行根治性切除术73例，根治切除率为26.9%（73/271），围手术期死亡率为6.8%（5/73）。其中56例行改良扩大的胰十二指肠切除术，1年和3年生存率分别为71.4%和33.9%。结论根治性胰十二指肠切除术是可切除胰头癌惟一可能提供治愈机会的治疗选择。加强术前评估并同时重视围手术期处理，有助于改善预后。
Sixteen cases unresectable carcinoma of the head of the pancreas complicated with jaundice were treated by one stage cholecysto-jejunal and gastro-jejunal loop double anastomosis, the same result of jaundice drainage and prevention of bile reflux were obtained when compared with simple cholecysto-jejunal loop anastomosis, on the other hand, the obstructive symptoms resulting from postoperative cancerous comppression of duodenum and pylorus were avoided as well. The operation is simple with less physiologic disturbance and the patient can lead better postoperative live.
Objective To evaluate the long-term efficacy of extended and standard surgery for carcinoma of head of pancreas by using meta-analysis. Methods Related articls （1990-2012） were searched in Pubmed， WOS， Embase， WanFang， SinoMed， and CNKI. Study on quality of these literatures were evaluated by using the Jadad score. The patients with pancreatic head carcinoma underwent extended radical resection and standard radical resection were classified to treatment group and control group， respectively. The mortality， morbidity， and survival rates of 1-， 3-， and 5-year after operation in the two groups were evaluated by using meta-analysis. Results A total of 11 studies fitted the selection crit-eria， including 744 patients. Among them 357 cases were in standard radical resection group and 387 cases in the extended radical resection group. The results of meta-analysis showed that： ①The morbidity after operation did not significantly differed between the extended radical resection group and standard radical resection group （OR=1.360， 95% CI=0.990-1.870， P=0.050）. ②The mortality of the two groups did not significantly differed （OR=0.870， 95% CI=0.430-1.760，P=0.700）. ③There were no significant differences in survival rates of 1-， 3-， and 5-year between the two groups （OR=0.880， 95% CI=0.450-1.720， P=0.710；OR=0.940， 95% CI=0.590-1.480，P=0.710；OR=1.000， 95% CI=0.600-1.67， P=1.000）. Conclusion Compared with standard radical resection， extended radical resection can not improve the survival rates of 1-， 3-， and 5-year after operation， and can’t reduce the mortality and morbidity after operation
Objective To explore the clinical therapeutic value of pancreatoduodenectomy in patients with carcinoma of ampulla of Vater (AVC). Methods The clinical data of 195 patients with AVC between March 1995 and March 2009 in this hospital were analyzed retrospectively. All the patients were divided into non-surgery group (n＝51), palliative surgery group (n＝96), and resection group (n＝48) according to the treatment methods. Results The 1-year, 3-year, and 5-year survival rates in the resection group were higher than those in the non-surgery group and the palliative surgery group (Plt;0.01). However, the incidence of complications in the resection group was higher than that in the nonsurgery group or the palliative surgery group (Plt;0.05). The radical resection rates, 1-year, 3-year, and 5-year survival rates of carcinomas of head of pancreas were significantly lower than those of carcinomas of the terminal of common bile duct or carcinomas of duodenal papilla (Plt;0.05, Plt;0.01). There was no significant difference of the perioperative mortality, complications rate, 1-year, 3-year, or 5-year survival rate between preoperative drainage jaundice group and preoperative nondrainage jaundice group (Pgt;0.05). The perioperative mortality in the resection group above the age of 70 years old was higher than that of less than or equal to 70 years old （Plt;0.05）. Compared with the non-surgery group or palliative surgery group, there were significant increasement of the incidence of serious or deadly perioperative complications in the resection group (Plt;0.05). Conclusions Surgical resection remains one of the most important measures of the treatment of AVC, in particular, the radical pancreatoduodenectomy is the only effect way for AVC, thus significantly prolonging the patient’s postoperative survivals and significantly improving the qualities of life.
Forty-five pancreatoduodenectomies had been performed in our hospital from 1981 to 1994, of which 35 cases were diagnosed as carcinomas of Vater’s ampulla or pancreatic head, and 10 (cases) as benign lesions. Through analysis of misdiagnosed cases, the authors emphasize that it is important to take correct history of jaundiced patients in detail according to the character of the jaundice and associated symptoms before any operation done. Secondly, all clinical materials must be thoroughly collected and special examinations for diagnosis should be chosen scientifically to avoid relying only on one sort of examination result as diagnostic standard. Thirdly, during operation the area of pancreatic head should be explored carefully and any lesions in doubt should be examined pathologically by puncture biopsy and frozen section to avoid misdiagnosis and thus performing pancreatoduodenectomy.
【Abstract】 Objective To summarize the experience in radical excision of carcinoma of head of pancreas in order to improve the surgical skills and reduce the occurrence of postoperative complications. Methods The clinical material of 55 patients (ages: 32-72 years; mean age: 56.5 years) with carcinoma of head of pancreas who received radical excision from January 1996 to March 2005 were analyzed retrospectively. All the cases were pathologically verified as ductal adenocarcinoma of head of pancreas. The treatment time following the operations was divided into two phases by year 2002 ( phaseⅠ: 1996-2002; phaseⅡ: 2002-2005). Different surgical treatment groups were fixed and ICU and other measures were implemented during the second phase. Results All the patients, consisting of 31 males and 24 females, underwent consecutive extended resection. The radically curative rates of phaseⅠand phaseⅡ were 25.9%(29/112) and 34.7%(26/75), respectively, and the complication rates were 48.3%（14/29） and 19.2%（5/26）, respectively. A variety of surgical skills would improve the operation, including extended regional lymphadenectomy, resection of involved nerve plexus, combined vessel resection and comprehensive bleeding-control technique and so on. Conclusion The improvement of radically curative effect and the reduction of complication rate depend on the advancement of surgical skills and the further understanding of pathophysiology of carcinoma of head of pancreas.