Vanhooser R, Organ C H
Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City.
J Natl Med Assoc. 1991 May;83(5):405-8.
In recent years, improved results with the Whipple operation have been reported because of improved case selection, thorough intraoperative assessment, aggressive nutritional management, and technical superiority. Ninety-four cases of pancreatic cancer using the Whipple procedure at the University of Oklahoma Health Sciences Center between 1980 and 1986 were reviewed. The median survival time for patients reviewed was 4.5 months; 1- and 2-year survival rates were 16% and 6%, respectively. No survivals at 5 years were observed. Those who underwent resection (Group A) survived 12.9 months with 1- and 2-year survival rates of 54% and 27%. Those undergoing bypass procedures (Group B) had a median survival time of 6 months, with 1- and 2-year survival rates of 16% and 4%. No statistical difference in survival distribution was observed between Groups A and B. The median survival time of patients receiving a staging laparotomy with no therapeutic intervention (Group C) was 2.3 months. Group D patients either refused abdominal exploration or demonstrated signs of inoperability. Surgical mortality in Groups A and B was 8% and 10%, respectively. We suggest that clinical Stage 1 and carefully selected Stage 2 cases of pancreatic cancer should be treated by pancreatoduodenectomy. Stage 3 and 4 patients warrant simultaneous duodenal-biliary by-passes.
近年来，由于病例选择的改善、术中评估的彻底性、积极的营养管理以及技术优势，据报道Whipple手术的效果有所改善。回顾了1980年至1986年间在俄克拉荷马大学健康科学中心采用Whipple手术治疗的94例胰腺癌病例。所回顾患者的中位生存时间为4.5个月；1年和2年生存率分别为16%和6%。未观察到5年生存率。接受切除术的患者（A组）生存12.9个月，1年和2年生存率分别为54%和27%。接受旁路手术的患者（B组）中位生存时间为6个月，1年和2年生存率分别为16%和4%。A组和B组之间在生存分布上未观察到统计学差异。接受分期剖腹探查但未进行治疗干预的患者（C组）的中位生存时间为2.3个月。D组患者要么拒绝腹部探查，要么表现出无法手术的迹象。A组和B组的手术死亡率分别为8%和10%。我们建议，临床1期和经过仔细选择的2期胰腺癌病例应采用胰十二指肠切除术治疗。3期和4期患者应同时进行十二指肠 - 胆管旁路手术。
