本文選題：胰十二指腸切除術(shù) + 常規(guī)手術(shù)　； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：背景:合并有壺腹腫瘤、膽管癌或胰頭癌的急腹癥患者在臨床上較為常見(jiàn),大型三甲醫(yī)院通過(guò)各種診療手段多能在術(shù)前明確診斷并在經(jīng)過(guò)充分的術(shù)前準(zhǔn)備后進(jìn)行PD手術(shù);但在有些情況下,剖腹手術(shù)患者可能在術(shù)中發(fā)現(xiàn)存在壺腹周?chē)[瘤,手術(shù)醫(yī)生需要面臨抉擇是否同時(shí)行PD手術(shù)的情況。這種兩難情況在發(fā)展中國(guó)家的基層醫(yī)院更為頻繁。緊急情況下,行一期PD手術(shù)或二期PD手術(shù)的手術(shù)指征以及治療效果尚缺乏臨床證據(jù)支持。資料方法:本研究收集了 2004年5月至2015年5月期間,在山東大學(xué)齊魯醫(yī)院和山西中心醫(yī)院就診的共計(jì)137例診斷明確行PD手術(shù)治療的患者以及27例緊急剖腹術(shù)中診斷為腹膜后或胰腺癌的患者的臨床資料。將27例緊急剖腹術(shù)中診斷為腹膜后或胰腺癌的患者按是否進(jìn)行同期切除分為2組,其中,10例患者接受了緊急一期PD手術(shù),17例患者接受了二期PD手術(shù)治療。通過(guò)卡方檢驗(yàn),Fisher檢驗(yàn)或Student t檢驗(yàn)分析了常規(guī)PD與急癥PD,一期PD和二期PD之間的手術(shù)花費(fèi)、治療效果以及并發(fā)癥情況。結(jié)果:與急癥PD相比,常規(guī)PD住院時(shí)間短(P0.001),出血少(P0.001),手術(shù)時(shí)間短(P0.001),成本較低(P0.001)。在急癥一期和二期PD之間,二期PD失血量少(P = 0.014),一期PD住院時(shí)間短(P = 0.004)、手術(shù)時(shí)間較短(P = 0.047)、治療費(fèi)用低(P = 0.003)。一期和二期PD患者在膽漏、胰瘺、術(shù)后出血等并發(fā)癥的發(fā)生率方面無(wú)顯著差別。結(jié)論:常規(guī)PD是治療壺腹周?chē)[瘤的最佳的治療方式,應(yīng)盡可能完善術(shù)前檢查,降低術(shù)中出現(xiàn)需要手術(shù)醫(yī)生進(jìn)行抉擇的情況的發(fā)生率。當(dāng)急癥PD不可避免時(shí),一期或二期PD的決定依賴于對(duì)患者總體狀況的判斷。一期行PD的患者住院時(shí)間短,手術(shù)時(shí)間短,治療費(fèi)用更少,二期行PD的患者血量較少。
[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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735

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