胰十二指肠切除术与胰体尾切除术：一项关于胰腺癌患者疗效、生存率及并发症发生率的研究
Whipple Procedure vs. Distal Pancreatectomy: A Study on the Efficacy, Survival Rates, and Complication Rates in Patients With Pancreatic Cancer.
作者信息
Siddique Hamza, Arshad Tarar Sabaina, Majeed Ahmed Salman, Hamza Muhammad, Saleem Raja Mueez, Haider Naqvi Muhammad, Zarar Muhammad, Chudhary Fizza, Qammar Bilal
机构信息
Internal Medicine, Social Security Hospital, Faisalabad, PAK.
General Surgery, Shalamar Hospital, Lahore, PAK.
出版信息
Cureus. 2025 Mar 24;17(3):e81091. doi: 10.7759/cureus.81091. eCollection 2025 Mar.
INTRODUCTION
Pancreatic cancer remains one of the most aggressive and challenging malignancies to treat, with limited options for curative interventions.
OBJECTIVE
The basic aim of the study is to find and compare the efficacy, survival rates, and complication rates of the Whipple procedure versus distal pancreatectomy in patients with pancreatic cancer.
METHODOLOGY
This retrospective observational study was conducted at Pakistan Kidney and Liver Institute, Lahore. Patients were enrolled from November 2018 to November 2019. Data were collected from 30 patients. Data were collected from the patient's medical records to evaluate and compare the outcomes of the two surgical approaches. The 30 patients were categorized into two equal groups based on the surgical intervention they received.
RESULTS
The mean age was comparable between groups, with an overall mean of 59.5 years. Tumors in Group A (Whipple procedure) were larger on average (3.8 ± 1.2 cm) compared to Group B (distal pancreatectomy; 3.2 ± 1.1 cm). Lymph node involvement was observed in 16 (53.3%) patients overall, with Group A showing a slightly higher rate (nine, 60%) compared to Group B (seven, 46.7%). Additionally, Group A had a higher mean number of lymph nodes removed (18) than Group B (15), while comorbidities were reported in 11 (36.7%) patients overall. The study found that the readmission rate was higher in Group A at three (20%), compared to two (13.3%) in Group B, reflecting the more complex and challenging postoperative course associated with the Whipple procedure.
CONCLUSION
The Whipple procedure, performed for pancreatic head tumors, offers better long-term survival but carries a higher risk of complications, including delayed gastric emptying and pancreatic fistulas. In contrast, distal pancreatectomy, used for tumors in the body or tail, is associated with lower surgical complexity and fewer complications but may have less favorable survival outcomes due to the later-stage presentation of these tumors. Additionally, the frequent need for splenectomy in distal pancreatectomy increases the risk of postoperative infections.
引言
胰腺癌仍然是最难治疗且最具挑战性的恶性肿瘤之一，根治性干预的选择有限。
目的
本研究的基本目的是寻找并比较胰腺癌患者中胰十二指肠切除术与胰腺远端切除术的疗效、生存率和并发症发生率。
方法
这项回顾性观察研究在拉合尔的巴基斯坦肾脏和肝脏研究所进行。患者于2018年11月至2019年11月入组。收集了30例患者的数据。从患者的病历中收集数据，以评估和比较两种手术方法的结果。根据患者接受的手术干预，将这30例患者分为两组，每组人数相等。
结果
两组的平均年龄相当，总体平均年龄为59.5岁。A组（胰十二指肠切除术）的肿瘤平均尺寸（3.8±1.2厘米）比B组（胰腺远端切除术；3.2±1.1厘米）更大。总体上有16例（53.3%）患者出现淋巴结受累，A组的发生率（9例，60%）略高于B组（7例，46.7%）。此外，A组切除的平均淋巴结数量（18个）高于B组（15个），总体上有11例（36.7%）患者报告有合并症。研究发现，A组的再入院率在3例（20%）时较高，而B组为2例（13.3%），这反映了胰十二指肠切除术相关的术后病程更复杂且更具挑战性。
结论
针对胰头肿瘤进行的胰十二指肠切除术能提供更好的长期生存，但并发症风险更高，包括胃排空延迟和胰瘘。相比之下，用于胰体或胰尾肿瘤的胰腺远端切除术手术复杂性较低且并发症较少，但由于这些肿瘤出现时处于较晚期，其生存结果可能不太理想。此外，胰腺远端切除术频繁需要进行脾切除术会增加术后感染的风险。
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