胰头癌的胰十二指肠切除术：保留幽门的胰十二指肠切除术与惠普尔手术对比

Pancreaticoduodenectomy for pancreatic head cancer: PPPD versus Whipple procedure.

作者信息

Lin Pin-Wen, Shan Yan-Shen, Lin Yih-Jyh, Hung Chung-Jye

机构信息

Department of Surgery, Institute of Clinical Medicine, School of Medicine National Cheng Kung University, Tainan, Taiwan.

出版信息

Hepatogastroenterology. 2005 Sep-Oct;52(65):1601-4.

PMID:16201125

Abstract

BACKGROUND/AIMS: Resectable carcinoma of the head of the pancreas can be treated with either standard (the Whipple) or pylorus-preserving pancreaticoduodenectomy (PPPD). Only a few reports compared the differences between these two procedures.

METHODOLOGY

From July 1994 to Oct 2002, a prospective randomized comparison between the Whipple procedure and PPPD done by the same surgeon for the patients with carcinoma of the head of the pancreas was conducted. Thirty-six patients diagnosed as pancreatic head adenocarcinoma were randomized to receive either the Whipple procedure or a PPPD. Three patients initially randomized to have a PPPD were converted to the Whipple procedure due to gross duodenal involvement. Finally, 19 patients received the Whipple procedure, 14 patients underwent PPPD and three patients had conversion.

RESULTS

Two perioperative deaths in the Whipple group and one perioperative death in PPPD resulted in an 8 percent mortality rate in the 36 patients. Median duration of the Whipple operation was 265 (range 203-475) min with a median blood loss of 570 (50-8540) mL. In the patients who had PPPD, median operating time was 232 (range 165-270) min, and median blood loss was 375 (range 100-1300) mL. There was one minor leak from the pancreaticojejunostomy in each group, resulting in a 5.5 percent minor leak in 36 patients. These outcomes were not significantly different. Delayed gastric emptying was observed more frequently after PPPD (six of 14 patients) than after the Whipple procedure (none of 19 patients) (P < 0.05). There was no significant difference between the Whipple procedure and PPPD in terms of median survival and 5-year survival rate. The median survival time was 16.0 months and 5-year survival rate was 9.4 percent in the 36 patients. Blood loss during operation influenced the prognosis.

CONCLUSIONS

There was no significant difference between the Whipple procedure and PPPD for the treatment of pancreatic head cancer in terms of operating time, blood loss, operative mortality and long-term survival. But delayed gastric emptying was more frequently encountered in PPPD than in the Whipple procedure.

摘要

背景/目的：可切除的胰头癌可采用标准术式（惠普尔手术）或保留幽门的胰十二指肠切除术（PPPD）进行治疗。仅有少数报告比较了这两种手术方式之间的差异。

方法

1994年7月至2002年10月，由同一位外科医生对胰头癌患者进行了惠普尔手术与PPPD之间的前瞻性随机对照研究。36例被诊断为胰头腺癌的患者被随机分为接受惠普尔手术组或PPPD组。最初随机分配接受PPPD的3例患者因十二指肠广泛受累而转为惠普尔手术。最终，19例患者接受了惠普尔手术，14例患者接受了PPPD，3例患者发生了术式转换。

结果

惠普尔手术组有2例围手术期死亡，PPPD组有1例围手术期死亡，36例患者的死亡率为8%。惠普尔手术的中位持续时间为265（范围203 - 475）分钟，中位失血量为570（50 - 8540）毫升。接受PPPD的患者，中位手术时间为232（范围165 - 270）分钟，中位失血量为375（范围100 - 1300）毫升。每组各有1例胰肠吻合口小渗漏，36例患者的小渗漏率为5.5%。这些结果无显著差异。PPPD术后延迟胃排空的发生率（14例患者中有6例）高于惠普尔手术后（19例患者中无1例）（P < 0.05）。惠普尔手术与PPPD在中位生存期和5年生存率方面无显著差异。36例患者的中位生存时间为16.0个月，5年生存率为9.4%。术中失血量影响预后。