Hoitsma H F, Meijer S, den Otter G
Arch Chir Neerl. 1978;30(3):151-61.
In the period 1965 to 1976 inclusive, 55 patients suffering from duodenopancreatic adenocarcinoma were surgically treated at the Free University Hospital. Twenty of these patients underwent a 'curative' Whipple pancreaticoduodenectomy for a resectable tumor. The difference in survival time makes a differentiation important between carcinomas occurring in the head of the pancreas and those of the peri-ampullary region. In our series, 11 of the former were found and 9 of the latter group. Of each group one patient died within 30 days of the operation. The average survival time of 9 patients, operated on for a tumor in the head of the pancreas, was 10.2 months, with a range from 2 to 23 months. One patient is still alive 23 months after the operation. The average survival time of 5 patients with a periampullary tumor was 22 months with a range from 6 to 52 months. Three patients are still alive, one more than 12 years and 2 more than 19 months after operation. Considering the bad results, and the fact that 30 percent of pancreatic carcinomas are multifocal, it would seem that the classical Whipple operation is a thing of the past. One can then make a plea for total pancreaticoduodenectomy or even for a regional pancreatectomy. Thirty-five patients underwent a palliative procedure, consisting of a biliary bypass combined in a number of cases with a gastroenterostomy. Five patients died within 30 days of the operation. The average survival time for the remaining patients was 9.5 months with a range of 1.5 to 30 months.
在1965年至1976年（含）期间，自由大学医院对55例十二指肠胰腺癌患者进行了手术治疗。其中20例患者因肿瘤可切除接受了“根治性”惠普尔胰十二指肠切除术。胰腺头部癌和壶腹周围区域癌患者的生存时间差异显著，因此区分两者很重要。在我们的系列研究中，发现前者11例，后者9例。每组各有1例患者在术后30天内死亡。9例接受胰腺头部肿瘤手术的患者平均生存时间为10.2个月，范围为2至23个月。1例患者术后23个月仍存活。5例壶腹周围肿瘤患者的平均生存时间为22个月，范围为6至52个月。3例患者仍存活，1例术后存活超过12年，2例超过19个月。考虑到治疗效果不佳以及30%的胰腺癌为多灶性这一事实，经典的惠普尔手术似乎已成为过去。因此，可以主张进行全胰十二指肠切除术甚至区域胰腺切除术。35例患者接受了姑息性手术，包括胆道旁路术，部分病例还联合了胃肠吻合术。5例患者在术后30天内死亡。其余患者的平均生存时间为9.5个月，范围为1.5至30个月。
