Outcome of Pancreaticoduodenectomy for Periampullary Cancer

胰頭十二指腸切除術治療胰頭周圍癌症成效

羅友翎(Yu-Ling Lo) ； 黃清水(Ching-Shui Huang) ； 連恒煇(Heng-Hui Lien)

《北市醫學雜誌》 17卷4期 (2020/12) Pp. 435-444

https://doi.org/10.6200/TCMJ.202012_17(4).0008

摘要

Objective: We conducted a single institutional outcome survey of 167 pancreaticoduodenectomies for periampullary cancers carried out in 1989 through 2019. Methods: Selected factors including health, disease, procedure, and complication were analyzed to explore their influences on short (mortality), mid (complications, hospital stay) and long (survival rate, postoperative survival months) term outcomes. Results: The 30-day mortality of the study group was 4.2%. Exteriorization of pancreatic juice during operation with drainage tube significantly decreased the surgical mortality (P ＜0.001). Lower preoperative albumin level was significantly correlated with increased incidences of two postoperative complications: visible bile drainage (P =0.025) and bleeding (P =0.04). History of DM was significantly correlated with an increased incidence of postoperative bleeding (P =0.027). Male gender demonstrated significant shorter postoperative hospital days than the female (P =0.01). Survival of the patients with CBD cancer was significantly lower than the patients with ampullary cancer (P =0.017). The postoperative survival months of the female patients was significantly longer than that of the male patients (P =0.041). Conclusions: Our study revealed a protective effect of exteriorization of pancreatic juice with drainage tube in the postoperative complications, and DM and low preoperative albumin level were the risk factors of pancreaticoduodenectomy. However, because of limited case number in our study, the prognoses of CBD and duodenal cancers after pancreaticoduodenectomy should be further examined. The comprehensive and long term follow-up of a single institute is the strength of our study.

關鍵字

pancreaticoduodenectomy ； periampullary cancer

並列摘要

目標：1989年至2019年，對167例胰頭周圍癌（胰頭癌74例，十二指腸壺腹癌65例，總膽管癌20例，十二指腸癌8例）病例進行胰頭十二指腸切除術之單一機構結果調查。方法：按健康、疾病、手術式、併發症等相關因素進行分析，探討其對短（死亡率）、中（併發症、住院日數）和長期（生存率、術後存活月數）的影響。結果：30天死亡率為4.2%。胰管外引流降低手術死亡率（P=0.001）。術前血中白蛋白濃度較低與術後可見吻合滲漏率（P=0.025）和出血（P=0.04）比率的增加顯著相關。糖尿病史與術後出血發生率增加（P=0.027）有顯著關聯。男性術後住院時間明顯較女性短（P=0.01）。總膽管癌患者的存活率明顯低於十二指腸壺腹癌患者（P=0.017）。女性患者術後存活月明顯長於男性患者（P=0.041）。結論：本研究確定胰管外引流是顯著術後併發症保護因素；糖尿病和低術前血中白蛋白濃度是手術重要危險因子。因研究病例數量有限；總膽管癌和十二指腸癌的預後應進一步確認，然而單一機構的整體長期分析則為本研究結論之有利基礎。

並列關鍵字

胰頭十二指腸切除術 ； 胰頭周圍癌