Department of Surgery, Haukeland University Hospital, Jonas Lies vei, N-5021 Bergen, Norway.
Eur J Surg Oncol. 2012 Mar;38(3):245-51. doi: 10.1016/j.ejso.2011.12.010. Epub 2012 Jan 2.
Report results following pancreatic surgery at a tertiary referral hospital in Norway, and our experience with the effects of preoperative use of common bile duct stents, the prophylactic efficacy of octreotide, and explore significant survival factors.
Prospective observational study of 275 patients during the years 1999-2009.
Ninety-two ductal adenocarcinomas were operated, and 183 cases were inoperable. Pylorus preserving pancreatico-duodenectomy (PPPD) was performed in 42 cases, a classic Whipple procedure (WP) in 38, distal resection in 6 and total pancreatectomy in 6 patients. Median size of the tumours was 3 cm R(0) resection was obtained in 54 patients. Lymph node metastases were found in 64 patients. 20% experienced postoperative intra-abdominal complications, and 30 days postoperative mortality was 4%. A routine use of somatostatine analogues postoperatively did not reduce the frequency of leakage. Two years survival was 34.6% and 5 years 11.8%, respectively.
Patients with ductal adenocarcinomas can be offered potential curative resections with acceptable rates of complication and mortality. Preoperative biliary stenting is still controversial and prophylactic octreotide should be used whenever the anastomosis is considered challenged and in cases of a soft pancreatic remnant. Five years all over survival has improved over the last decade from <5% to >11%.
报告挪威一家三级转诊医院胰腺手术后的结果，以及我们在术前使用胆总管支架、奥曲肽预防效果方面的经验，并探讨显著的生存因素。
对 1999 年至 2009 年期间的 275 例患者进行前瞻性观察研究。
共手术治疗 92 例导管腺癌，183 例不可手术。行保留幽门的胰十二指肠切除术（PPPD）42 例，经典胰十二脂肠切除术（WP）38 例，胰体尾部切除术 6 例，全胰切除术 6 例。肿瘤平均大小为 3cm，R0 切除 54 例。64 例患者有淋巴结转移。20%的患者术后发生腹腔内并发症，30 天术后死亡率为 4%。术后常规使用生长抑素类似物并未降低漏液的频率。2 年生存率为 34.6%，5 年生存率为 11.8%。
导管腺癌患者可接受潜在的根治性切除术，并发症和死亡率可接受。术前胆道支架置入仍存在争议，只要吻合口被认为具有挑战性，且胰腺残端较软，就应预防性使用奥曲肽。与过去十年相比，5 年总生存率从<5%提高到>11%。
