Evans D B, Termuhlen P M, Byrd D R, Ames F C, Ochran T G, Rich T A
Department of Surgical Oncology, University of Texas, M.D. Anderson Cancer Center, Houston.
Ann Surg. 1993 Jul;218(1):54-60. doi: 10.1097/00000658-199307000-00009.
To determine the morbidity and mortality of pancreaticoduodenectomy followed by electron-beam intraoperative radiation therapy (EB-IORT).
Local recurrence following pancreaticoduodenectomy occurs in 50% to 90% of patients who undergo a potentially curative surgical resection for adenocarcinoma of the pancreatic head. To improve local disease control, a more aggressive retroperitoneal dissection has been combined with adjuvant EB-IORT.
Forty-one patients with malignant neoplasms of the periampullary region underwent pancreaticoduodenectomy followed by EB-IORT between January 1989 and May 1992. EB-IORT was delivered in a dedicated operative suite, eliminating the need for patient relocation. Electron-beam energies of 6 to 12 MeV were used to deliver 10 to 20 Gy to the treatment field following resection but before pancreatic, biliary, and gastrointestinal reconstruction.
Median operative time was 9 hours, blood loss was 1 L, perioperative transfusion requirement was 2 units, and hospital stay was 20 days. One patient died of a postoperative myocardial infarction, and four patients required reoperation, one for an anastomotic leak. No patient failed to receive EB-IORT because of operative complications during the time period of this study.
Adjuvant EB-IORT after pancreaticoduodenectomy can be delivered safely, with low mortality and acceptable morbidity.
确定胰十二指肠切除术后行电子束术中放射治疗（EB - IORT）的发病率和死亡率。
胰十二指肠切除术后局部复发发生在50%至90%接受胰头腺癌潜在根治性手术切除的患者中。为改善局部疾病控制，更积极的腹膜后淋巴结清扫术已与辅助性EB - IORT联合应用。
1989年1月至1992年5月期间，41例壶腹周围区域恶性肿瘤患者接受了胰十二指肠切除术后行EB - IORT。EB - IORT在专用手术室进行，无需患者重新安置。在切除术后但在胰腺、胆道和胃肠道重建之前，使用6至12 MeV的电子束能量向治疗区域给予10至20 Gy的剂量。
中位手术时间为9小时，失血量为1升，围手术期输血需求量为2单位，住院时间为20天。1例患者死于术后心肌梗死，4例患者需要再次手术，1例因吻合口漏。在本研究期间，没有患者因手术并发症而未接受EB - IORT。
胰十二指肠切除术后辅助性EB - IORT可以安全实施，死亡率低且发病率可接受。
