李卓锴　张坤　谭炜　郭敬强　涂朝勇　朱锦德

[關键词] 胰头导管癌;保留幽门胰十二指肠切除术;标准胰十二指肠切除术;临床效果

[中图分类号] R735.9          [文献标识码] B          [文章编号] 1673-9701（2021）17-0049-04

Comparison of clinical effects of different pancreaticoduodenectomy in the treatment of ductal pancreatic head carcinoma

LI Zhuokai   ZHANG Kun   TAN Wei   GUO Jingqiang   TU Chaoyong   ZHU Jinde

Department of Hepatobiliary and Pancreatic Surgery， Lishui Central Hospital in Zhejiang Province， Lishui   323000， China

[Abstract] Objective To explore the clinical effects of different pancreaticoduodenectomy in the treatment of ductal pancreatic head carcinoma. Methods A total of 56 patients with ductal pancreatic head carcinoma who were diagnosed and treated in our hospital from January 2015 to May 2019 were selected as the research subjects for a retrospective study.They were divided into an observation group and a control group， with 28 cases in each group. Patients in the observation group were treated with pylorus-preserving pancreaticoduodenectomy （PPPD）. Patients in the control group were treated with standard pancreaticoduodenectomy （SPD）. The general clinical data，intraoperative and postoperative indicators （intraoperative blood loss， duration of operation， gastric tube indwelling time and length of hospital stay） were compared between the two groups of patients， and the incidence rate of postoperative complications （delayed gastric emptying， intra-abdominal infection， biliary fistula and pancreatic fistula） was investigated. Results There was no statistically significant difference between the two groups in age， gender， history of abdominal surgery， body mass index， total bilirubin， hemoglobin， and albumin（P>0.05）; there was no statistically significant difference between the two groups in the indwelling time of the gastric tube and the length of hospital stay（P>0.05）; the duration of operation in the observation group was significantly shorter than that in the control group， and the intraoperative blood loss was significantly lower than that in the control group. The differences were statistically significant（P<0.05）; the total incidence rate of postoperative complications in the observation group was of 3 cases（10.71%）， and the total incidence rate of postoperative complications in the control group was of 4 cases （14.28%）， the differences were not statistically significant（P>0.05）. Conclusion Compared with the standard pancreaticoduodenectomy， the pylorus-preserving pancreaticoduodenectomy has a shorter duration of operation and less intraoperative blood loss. The safety of both procedures is higher.

[Key words] Ductal pancreatic head carcinoma; Preserving pancreaticoduodenectomy; Standard pancreaticoduodenectomy; Clinical effects

胰腺癌为消化系统的常见致死性癌肿，起病较为隐匿，病情进展迅速，多数患者确诊时已为晚期，临床主要表现为黄疸、腹部不适、消瘦、乏力等，手术为胰腺癌患者获得长期生存的唯一治疗手段[1-2]，胰头十二指肠切除术（Pancreaticoduodenectomy，PD）为临床根治远端胆管癌、胰头癌及壶腹癌最为有效的手术方式之一，标准胰十二指肠切除术主要对胰肠、胃肠及胆肠进行消化道重建，该术式较为成熟、术中风险低，但具有吻合步骤较多，手术时间较长等缺点。近年来保留幽门胰十二指肠切除术快速普及，其适应证不断扩大，临床应用较多，相较于胰头十二指肠切除术，保留患者完整的幽门，不切除胃窦，且术后恢复快[3-5]。基于此，本研究观察不同胰十二指肠切除术治疗胰头导管癌的临床效果，现报道如下。

1 资料与方法

1.1 一般资料

选取2015年1月至2019年5月于我院诊治的胰头导管癌患者56例作为研究对象进行回顾性研究，其中男36例，女20例。纳入患者分为观察组与对照组，每组各28例。纳入标准：①内镜检查及病理诊断均显示为胰头导管癌;②年龄>18岁。排除标准：①凝血功能异常且具有明显出血倾向的患者;②严重心肺功能异常患者;③肝内外胆管恶性疾病患者;④妊娠及哺乳期女性患者;⑤严重脑血管疾病患者;⑥不能耐受全身麻醉的患者。

1.2……