Delcore R, Thomas J H, Hermreck A S
Department of Surgery, University of Kansas Medical Center, Kansas City 66160-7309.
Am J Surg. 1991 Dec;162(6):532-5; discussion 535-6. doi: 10.1016/0002-9610(91)90104-l.
Forty-two patients (age range: 70 to 86 years) underwent pancreaticoduodenectomy between 1970 and 1990 for carcinomas of the pancreas (23), ampulla (8), common bile duct (5), duodenum (5), or islet cells (1). After resection, reconstruction was done by either pancreaticojejunostomy (13) or pancreaticogastrostomy (25); four patients had total pancreatectomy. The mean duration of operation was 5 hours, the mean blood loss was 2,200 mL, the mean transfusion requirement was 4 units of blood, and mean length of hospitalization was 22 days. There were no leaks or other complications related to the pancreatic anastomoses. Six (14%) major complications occurred including two (5%) operative deaths. Mean survival was 42 months (range: 2 to 219 months) for the entire group and 35 months for patients over the age of 80. This experience suggests: (1) pancreaticoduodenectomy can be performed with low operative morbidity and mortality in elderly patients, and advanced age should not be considered a contrainindication to this potentially curative procedure; (2) pancreaticogastrostomy is a safe and easy alternate method of reconstruction; and (3) prolonged survival is possible for elderly patients following pancreaticoduodenectomy for malignant pancreatic and periampullary neoplasms.
1970年至1990年间，42例患者（年龄范围：70至86岁）因胰腺癌（23例）、壶腹癌（8例）、胆总管癌（5例）、十二指肠癌（5例）或胰岛细胞瘤（1例）接受了胰十二指肠切除术。切除术后，通过胰空肠吻合术（13例）或胰胃吻合术（25例）进行重建；4例患者接受了全胰切除术。平均手术时间为5小时，平均失血量为2200毫升，平均输血需求量为4个单位的血液，平均住院时间为22天。未发生与胰腺吻合相关的渗漏或其他并发症。发生了6例（14%）严重并发症，包括2例（5%）手术死亡。整个组的平均生存期为42个月（范围：2至219个月），80岁以上患者的平均生存期为35个月。该经验表明：（1）老年患者进行胰十二指肠切除术的手术发病率和死亡率较低，高龄不应被视为这一潜在根治性手术的禁忌证；（2）胰胃吻合术是一种安全、简便的替代重建方法；（3）老年患者在因恶性胰腺和壶腹周围肿瘤接受胰十二指肠切除术后有可能获得较长生存期。
