| Background：They are have been widely studied that pancreatic cancer is poor prognosisof tumor and resection of pancreatic duodenal is a classic surgical treatment ofpancreatic head carcinoma.If can achieve R0radical resection, will greatlyimprove the patients’ survival, improve patient quality of life.However in clinicalcan achieve real R0resection in patients with less, even if the preoperativeassessment can be radical resection, postoperative pathological return often cutedge of tumor mostly positive or local lymph node metastasis.This kind ofcircumstance belongs to R1resection.The survival rate of the R1resection ofsurvival will be dramatically reduced than R0resection.For pancreatic headcarcinoma invasion peripheral vascular, the pancreas radioactive particlesimplantation or radical resection, has not been determined which is better.Thispaper mainly research on peripheral vascular pancreatic head carcinoma ofpancreas radioactive particles implantation and radical resection but patients withpostoperative pathological for R1resection for contrast research, through therelevant indicators, a comprehensive evaluation system of two kinds of operationin advanced pancreatic head cancer treatment application value.Objective:A retrospective analysis about the advantages and disadvantages betweeninfringement of peripheral vascular of pancreatic head carcinoma in the pancreasradioactive particles implantation+biliary intestinal anastomosis+gastrointestinal anastomosis and pancreaticoduodenal resection surgery that the pathologyproved R1resection of the Pancreatic cancer.Main comparative indicators:thesurvival rate, incidence of postoperative complications, postoperative hospital stay, hospitalization cost, operation time, intraoperative blood loss, postoperativetumor metastasis, tumor pain relief after surgery, postoperative eating time,postoperative bed time, postoperative recovery of liver function.Throughcomparing the indicators, the advantages and disadvantages of the systemevaluation of pancreaticoduodenal resection and pancreas radioactive particlesimplantation, and help clinicians in the clinical work to choose more appropriatesurgical treatment of infringement of peripheral vascular of pancreatic headcarcinoma.Methods:The first clinical hospital of jilin university were retrospectively analyzedbetween January2011and January2011,a total of25patients with pancreaticcancer. Line of radioactive particles implantation+biliary intestinal anastomosis+gastrointestinal anastomosis is13cases that the case is pancreatic invasionperipheral vascular,infringement of peripheral vascular pancreatic headcarcinoma of pancreaticoduodenal resection is12cases, but the postoperativepathology, cutting edge are all positive so returns in for R1resection.Thepancreatic head carcinoma line radioactive particles implantation+pancreas bileintestinal anastomosis+gastrointestinal anastomosis of the inclusion criteria:(1).All patients into the group for the diagnosis of pancreatic cancer.(2). Make thesurrounding blood vessels (e.g., superior mesenteric vein, portal vein), but did notinfringe peripheral artery (e.g., superior mesenteric artery).(3). On preoperativeimaging of upper gastrointestinal tract prompt oppression duodenum, pancreatichead carcinoma in upper gastrointestinal tract obstruction (4) age70years old orless.(5). The cardiopulmonary function, blood coagulation index is normal.(6),preoperative liver function index: after adjusting total bilirubin200umol/l, orless albumin acuity30g/l.Exclusion criteria:(1). Adenocarcinoma of thepancreas is not important blood vessels around the infringement.(2). Age>70years old.(3) the cardiopulmonary function, clotting abnormalities.(4).Postoperative allowed visitors.(5). Metastatic pancreatic cancer (mainly the liver). Pancreatic head carcinoma resection of pancreatic duodenal resection of inclusioncriteria:(1). All patients into the group for the definite diagnosis of pancreaticcancer.(2). Make the surrounding blood vessels (e.g., superior mesenteric vein,portal vein), but did not infringe peripheral artery (e.g., superior mesentericartery).(3). The postoperative pathological return cut edge visible carcinomainfiltration, for R1resection.(4). Age are70years old or less.(5). Thecardiopulmonary function, blood coagulation index is normal.(6), preoperativeliver function index: after adjusting total bilirubin200umol/l, or less albuminacuity30g/l. Exclusion criteria:(1). Adenocarcinoma of the pancreas is notimportant blood vessels around the infringement.(2). Age>70years old.(3) thecardiopulmonary function, clotting abnormalities.(4). Postoperative allowedvisitors.(5). Metastatic pancreatic cancer (mainly the liver).Results:According to the inclusion criteria and exclusion criteria, included25patients, including line radioactive particles implantation+biliary intestinalanastomosis+gastrointestinal anastomosis is13cases, pancreaticoduodenalresection is12cases. Treatment for infringement of peripheral vascularpancreatic head carcinoma of pancreas radioactive particles implantation andresection of pancreatic duodenal comparison results are as follows:The averagesurvival period (month)(9.27±1.36VS8.91±1.31，t=0.083, p=0.773); averageincidence of postoperative complications (75.00%vs46.15%, χ2=2.163,p=0.141), postoperative complications: each pancreatic fistula (5(41.67%) vs1(7.69%), χ2=4.338，p=0.037), intraperitoneal bleeding (1(8.33%) vs1(7.69%),χ2=2.433, p=0.119), biliary fistula ((1(8.33%) vs1（7.69%), χ2=2.433，p=0.119),gastric emptying disorder (1(8.33%) vs1(7.69%), χ2=2.433, p=0.119), thestomach anastomotic fistula (0(0.00%)vs1(7.69%)，χ2=0.962，p=0.327), andabdominal cavity infection (1(8.33%) vs1(7.69%), χ2=2.431, p=0.119).Postoperative hospital stay (day)(15.6±5.3VS5.3±3.6, t=3.997, p=0.001), intraoperative blood loss (ml)(287±79VS128±24, t=7.052, p<0.0001), averagehospitalization cost (RMB)(78634±475VS138880±4423, t=5.472, p <0.0001),the average time (min)(246±42VS128±24, t=8.092, p <0.0001), patients withpostoperative pain remission rate (58(93.54%)VS24(75%), χ2=5.08, p=0.024),postoperative cancer liver metastases rate for1year (29(47.05%) VS24(75%),χ2=6.838, p=6.838)；exhaust time (postoperative days)(3.71±1.13VS4.23±1.33,t=0.443, p＞0.05)； the meal time (postoperative days)(4.23±3.96VS7.64±4.85，t=4.112，p<0.05)；bed activity time (postoperative days)(3.35±2.46VS6.25±3.45，t=5.033，p<0.05)。Conclusion：Through the analysis of the results we can obtain:(1) the pancreasradioactive particles implantation is an effective method in recent rise in thetreatment of pancreatic cancer that is mainly used in the clinical treatment ofadvanced pancreatic, through the clinical curative effect observation, the pancreasradioactive particles implantation in can continue to kill cancer cells, do not haveharm to the normal tissue almost, hospitalization expenses low, short hospital stay,fewer complications, and can effectively prolong the patient’s survival, so for theinfringement of peripheral vascular to R0resection of pancreatic cancer may bemore advantageous line radioactive particles implantation for patients withpancreas.(2) to not miss the optimal timing of surgery in patients with pancreaticcancer, can undertake R0radical resection of pancreatic head carcinoma is radicalresection is the preferred method, successful removal of the tumor patients withits average survival period will be extended obviously.(3) as the research samplesize is less, there are individual differences, is currently not exact conclusion,later still need further evidence for infringement of massive investigation andstudy of peripheral vascular particle implantation and pancreatic duodenalpancreatic cancer resection of which better curative effect. |
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