Tsao J I, Rossi R L, Lowell J A
Department of General Surgery, Lahey Clinic, Burlington, Mass.
Arch Surg. 1994 Apr;129(4):405-12. doi: 10.1001/archsurg.1994.01420280081010.
To assess the adequacy of pylorus-preserving pancreatoduodenectomy (PPPD) as a definitive surgical treatment for primary malignant diseases of the periampullary region.
Retrospective review of the clinical records of patients undergoing PPPD for malignant diseases of the periampullary region. Median and 5-year actuarial survival by type and stage of cancer were determined. Survival data from this study were compared with those of patients undergoing a conventional Whipple operation.
Lahey Clinic, Burlington, Mass.
One hundred six patients undergoing PPPD for primary malignant disease of the periampullary region between November 1979 and June 1992.
Pylorus-preserving pancreatoduodenectomy was performed with curative intent in the 106 patients. Ninety-five patients underwent proximal pancreatectomy; 11 patients, total pancreatectomy. Resection of the portal vein was performed in 10 patients.
Long-term survival following PPPD was analyzed with respect to the type and stage of cancer. Median follow-up was 30 months (range, 6 to 156 months).
Five-year actuarial survival rates were 45.4% for patients with ampullary adenocarcinoma; 6.6%, with pancreatic ductal adenocarcinoma; 33.3%, with distal bile duct adenocarcinoma; 75%, with pancreatic islet cell adenocarcinoma; and 0%, with pancreatic cystadenocarcinoma. An early cancer stage was associated with more favorable survival for ampullary and distal bile duct adenocarcinomas. For pancreatic ductal adenocarcinoma only, tumors less than 2 cm were associated with better survival. Duodenal resection margins were free of disease in all patients, while peripancreatic and retroperitoneal extension of the tumor was found in 20%.
For patients with periampullary malignant disease, long-term survival following PPPD is similar to that following a conventional Whipple operation. The potential benefits of hemigastrectomy with perigastric lymphadenectomy are frequently obviated by the presence of positive margins and lymph nodes elsewhere, ie, in the retroperitoneum. We advocate PPPD as the procedure of choice for locally resectable malignant disease of the periampullary region, provided the duodenal margin is viable and tumor free.
评估保留幽门的胰十二指肠切除术（PPPD）作为壶腹周围区域原发性恶性疾病确定性手术治疗的充分性。
对因壶腹周围区域恶性疾病接受PPPD治疗的患者临床记录进行回顾性分析。确定癌症类型和分期的中位生存期及5年精算生存率。将本研究的生存数据与接受传统Whipple手术的患者的数据进行比较。
马萨诸塞州伯灵顿市拉希诊所
1979年11月至1992年6月期间106例因壶腹周围区域原发性恶性疾病接受PPPD治疗的患者。
对106例患者进行了保留幽门的胰十二指肠切除术，目的是治愈。95例患者接受了近端胰腺切除术；11例患者接受了全胰腺切除术。10例患者进行了门静脉切除。
分析PPPD术后的长期生存率与癌症类型和分期的关系。中位随访时间为30个月（范围6至156个月）。
壶腹腺癌患者的5年精算生存率为45.4%；胰腺导管腺癌患者为6.6%；远端胆管腺癌患者为33.3%；胰岛细胞腺癌患者为75%；胰腺囊腺癌患者为0%。早期癌症分期与壶腹和远端胆管腺癌更有利的生存率相关。仅对于胰腺导管腺癌，肿瘤小于2 cm与更好的生存率相关。所有患者的十二指肠切缘均无疾病，而20%的患者发现肿瘤有胰周和腹膜后浸润。
对于壶腹周围恶性疾病患者，PPPD术后的长期生存率与传统Whipple手术后相似。由于切缘阳性和其他部位（即腹膜后）淋巴结转移的存在，半胃切除术加胃周淋巴结清扫术的潜在益处常常被抵消。我们主张，对于壶腹周围区域局部可切除的恶性疾病，若十二指肠切缘存活且无肿瘤，PPPD是首选术式。
