术中偶然发现壶腹部占位行一期或二期胰十二指肠切除术的治疗效果评价

发布时间：2018-05-17 13:10

本文选题：胰十二指肠切除术 + 常规手术　；参考：《山东大学》2017年硕士论文

【摘要】：背景:合并有壶腹肿瘤、胆管癌或胰头癌的急腹症患者在临床上较为常见,大型三甲医院通过各种诊疗手段多能在术前明确诊断并在经过充分的术前准备后进行PD手术;但在有些情况下,剖腹手术患者可能在术中发现存在壶腹周围肿瘤,手术医生需要面临抉择是否同时行PD手术的情况。这种两难情况在发展中国家的基层医院更为频繁。紧急情况下,行一期PD手术或二期PD手术的手术指征以及治疗效果尚缺乏临床证据支持。资料方法:本研究收集了 2004年5月至2015年5月期间,在山东大学齐鲁医院和山西中心医院就诊的共计137例诊断明确行PD手术治疗的患者以及27例紧急剖腹术中诊断为腹膜后或胰腺癌的患者的临床资料。将27例紧急剖腹术中诊断为腹膜后或胰腺癌的患者按是否进行同期切除分为2组,其中,10例患者接受了紧急一期PD手术,17例患者接受了二期PD手术治疗。通过卡方检验,Fisher检验或Student t检验分析了常规PD与急症PD,一期PD和二期PD之间的手术花费、治疗效果以及并发症情况。结果:与急症PD相比,常规PD住院时间短(P0.001),出血少(P0.001),手术时间短(P0.001),成本较低(P0.001)。在急症一期和二期PD之间,二期PD失血量少(P = 0.014),一期PD住院时间短(P = 0.004)、手术时间较短(P = 0.047)、治疗费用低(P = 0.003)。一期和二期PD患者在胆漏、胰瘘、术后出血等并发症的发生率方面无显著差别。结论:常规PD是治疗壶腹周围肿瘤的最佳的治疗方式,应尽可能完善术前检查,降低术中出现需要手术医生进行抉择的情况的发生率。当急症PD不可避免时,一期或二期PD的决定依赖于对患者总体状况的判断。一期行PD的患者住院时间短,手术时间短,治疗费用更少,二期行PD的患者血量较少。
[Abstract]:Background: patients with acute abdomen complicated with ampullary tumor, cholangiocarcinoma or pancreatic head cancer are more common in clinic. Large triple A hospitals can make a definite diagnosis before operation and carry out PD operation after adequate preoperative preparation. In some cases, however, periampullary tumors may be found in patients undergoing laparotomy, and the surgeon has to decide whether to perform PD at the same time. Such dilemmas are more frequent in primary hospitals in developing countries. In case of emergency, the indication and therapeutic effect of one stage PD operation or two stage PD operation are not supported by clinical evidence. Data methods: the study collected data from May 2004 to May 2015, Clinical data of 137 patients who were diagnosed by PD operation and 27 patients who were diagnosed as retroperitoneal or pancreatic cancer during emergency laparotomy in Qilu Hospital and Shanxi Central Hospital of Shandong University. Twenty-seven patients diagnosed as retroperitoneal or pancreatic cancer during emergency laparotomy were divided into two groups according to whether or not they underwent simultaneous resection. Among them, 10 patients received emergency primary PD surgery and 17 received second-stage PD surgery. Through chi-square test, Fisher test or Student t test, the surgical cost, therapeutic effect and complications between routine PD and emergency PD, primary PD and secondary PD were analyzed. Results: compared with emergency PD, conventional PD had shorter hospitalization time (P 0.001), less bleeding (P 0.001), shorter operation time (P 0.001) and lower cost (P 0.001). Between the first stage and the second stage of PD, the blood loss of the second stage PD was less than that of the control group (P = 0.014), the hospitalization time of the first stage PD was shorter than that of the control group (P = 0.004), the operation time was shorter than that of the control group (P = 0.047), and the cost of the treatment was low (P = 0.003). There was no significant difference in the incidence of biliary leakage, pancreatic fistula, postoperative hemorrhage and other complications between primary and secondary PD patients. Conclusion: conventional PD is the best treatment for periampullary tumors. When acute PD is inevitable, the decision of one or two PD depends on the judgment of the patient's overall condition. The first stage PD patients had shorter hospitalization, shorter operation time, less treatment cost, and less blood volume in the second stage PD patients.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735

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