【摘要】 目的　提高胰头及壶腹部癌手术切除率 ,减少并发症及提高术后生存率。方法　总结 2 6例胰头十二指肠切除术的治疗经验。结果　对 2 6例胰头及壶腹部癌患者根据肿瘤不同分期行不同范围扩大切除及淋巴结清扫术 ,并行改良Child重建术。切除范围注重区域性整块切除 ,包括周围淋巴结清扫。消化道重建采用胰肠、胆肠端侧吻合。手术时间 4.0～ 6.5h(平均 4.6h) ,术中平均失血 5 0 0ml,手术并发症发生率为 15 .4% (4 / 2 6)。术后 1、3、5年生存率分别为 69.2 % (18/ 2 6)、46.2 % (12 / 2 6)、2 3 .1%(6/ 2 6)。结论　胰头十二指肠切除术应由专业组人员完成。不同范围的清扫可降低肿瘤局部复发率。胰肠、胆肠端侧吻合操作不复杂 ,术后并发症发生率较低更多还原

【Abstract】 Objective To reduce postoperative complication and increase resection rates or survival after extirpation for patients with carcinoma of Vater ampulla and head of pancreas.Methods The clinical data from 26 cases of pancreaticoduodenectomy(PD) were analyzed.Results The modified standard operations consisted of PD with extended resection and D2 D3 lymth node dissection according to intraoperative stage of tumor.Ameliorated Child reconstruction was performed in all patients.The therapeutie consequence for tumors was an extended lymphatic and significant soft tissue dissecrtion that goes beyond the regional lymph node stations.The major anastomoses consisted of end to side pancreatojejunostomy and choldeochojejunostomy.Median duration of PD was 4.6 hours(range 4.0～6.5 hours),with a median blood loss of 500 ml.The overall postoperative complications were 15.4%(4/26).The 1 ,3 and 5 year survival rates were 69.2%(18/26)?46.2%(12/26) and 23.1%(6/26),respectively.Conclusion PD should be performed by specifical surgeons.Extended dissection could reduce the recurrence and improve the postoperative survival.It is not a complex procedure for end to side pancreatojejunostomy and choledochojejunostomy,which could decrease the leakage.更多还原