Explore The Efficacy Of Different Surgical Peri Ampullar Carcinoma

ObjectiveTo summarize the operation treatment of periampullary carcinoma and carcinoma ofhead of pancreas， explore the different operation in the early ostoperative complicationrate，operation mortality，postoperative hospital stay and postoperative survival rate.MethodReview clinical data of142patients with periampullary carcinoma operationtreatment from1998January to2011January in Department of general surgery ofAffiliated Hospital of Taishan Medical University. According to the location of the tumor，they are divided into pancreatic head carcinoma group（group A） and periampullarycarcinoma group （group B）； According to the different operation，we devided group Ainto pancreaticoduodenectomy group （group A1）and palliative operation group （groupA2）；group B into pancreaticoduodenectomy （group B1），local excision and the junctionof pancreaticobiliary duodenal resection group (group B2)， palliative operation group(group B3)；Comparing the differences in the rate of operation mortality， incidence ofearly postoperative complications，postoperative hospital stay，postoperative recurrenceand postoperative survival rate.ResultsGroup A1of30cases，22were male（73.33%）， female8cases（26.67%）， meanage （55.30±12）years；36cases in group A2，26cases were male（72.22%），10casesof female（27.78%），mean age（58.58±11.31）years old. Group B1of35cases，24casesof male patients（68.57%）， female11cases（31.43）， mean age（54.03±11.79）years；15cases in group B2，9cases of male patients（60%），6cases of female（40%）， age42-66years old， mean age（53.20±7.89）； B3group26cases，18male patients（69.23%），8cases of female（30.77%）， average （56.62±13.45）years old.Between the groups in general situation，there are no differences of Statistic（sP>0.05）.In group A1，1case died from MODS（Multiple organ failure）， The mortality rate was3.33%， theaverage postoperative hospital stay was（24.72±10.11）days；The other29cases lefthospital after the condition improved， the average postoperative hospital stay in A2groupwas（16.67±5.65）days，significantly shorter than that in the A1group，between the twogroups there were significant differences （P <0.05）， the postoperative mortality （0%）was lower than that of A1group，by the statistical analysis， there was no significantdifference between the two groups（P>0.05）.In groupB1，1patients die from pancreaticfistula and biliary fistula，the mortality rate was2.86%，the average hospital stay was（24.72±10.11）days；group B2，mean hospital stay after operation（16.00±3.09）days，group B3， mean hospital stay after operation（16.67±5.65）days，group B2，B3werelower than B1，comparing the difference was statistically significant（P<0.05），B2，B3group hospital stay was not statistically different （P>0.05）.In the group A1，9patients（30%） had postoperative complications；In group A2，4patients（11.11%）hadcomplications，postoperative complications in A1group was higher than that in A2group，but there was no statistically significant difference between them（P>0.05）.In group B1，8patients（22.86%）had postoperative complications，1patients of intestinal obstruction ingroup B2，3case（s11.54%）in group B3appeared complications，the complication rate wasno significant difference（P>0.05）. Each group had no statistical difference in dropout rate.The survival rates of group A1about postoperative1years，2years，3year were62.07%，35.71%，26.92%，the survival rates of group A2about postoperative1years，2years，3year were16.67%、6.06%、0，the survival rate of group A1was higher than that in groupA2，the difference has statistical significance（P<0.05）.The survival rates of group B1about postoperative1years，2years，3years were76.47%，62.50%，48.39%，group B2were93.33%，86.67%，86.67%，group B3were42.31%、12.00%、0，the survival rateabout postoperative1years，2years between group B1and group B2had no statisticaldifference（P>0.05），the survival rate about postoperative3years，group B2was higherthan in group B1， the difference had statistically significan（tP<0.05）； the survival ratesof group B1，B2about postoperative1，2，3year were higher than group B3， thedifference had statistically significant（P<0.05）.The3-year cumulative recurrence rate of group B1was3.23%，group B2was6.67%，group B1and B2had no difference inStatistics（P>0.05）.Conclusions1、Local resection has the advantage of shorter postoperative hospitalization time，lower operation complication rate，if the tumor is limited， smaller than2cm in diameter，without lymph node metastasis can be used as the preferred mode of operation.2、The junction of pancreaticobiliary duodenal resection has the advantage of smallerresection scope， shorter postoperative hospitalization time and the lower rate ofcomplications， the treatment effect was satisfactory，if the tumor invasionand pancreatic≤2cm， without lymph node metastasis，it can be used as the preferred mode of operation.3、Pancreaticoduodenectomy can be used as the preferred treatment of pancreatic headcarcinoma and periampullarycarcinoma progression.