|
Results of surgical treatment of 216 cases of pancreatic and ampullary cancer from 1962 to 1982 were analyzed. From 1962-1977, 114 cases were operated and in the second period, from 1978-1982, 102 cases. From 1962-1977, 8.8% of the cases conformed to Hermreck's criterion stage I, and from 1978-1982, 19.6% cases. The resectability of cancer of pancreatic head was 25.6% in the first period and 37.7% in the second period. Postoperatively, the 1 year-survival rate was 50% and 61% in the first and second period respectively.... Results of surgical treatment of 216 cases of pancreatic and ampullary cancer from 1962 to 1982 were analyzed. From 1962-1977, 114 cases were operated and in the second period, from 1978-1982, 102 cases. From 1962-1977, 8.8% of the cases conformed to Hermreck's criterion stage I, and from 1978-1982, 19.6% cases. The resectability of cancer of pancreatic head was 25.6% in the first period and 37.7% in the second period. Postoperatively, the 1 year-survival rate was 50% and 61% in the first and second period respectively. As to the 3 year-survival rate, it was 8.3% and 15.3% respectively. The 5 year-survival rate was nil and 11.1% respectively. The reasons for the improvement in prognosis were thought to be: (1)Specialists in this field were organized and OPD for hepato-biliary diseases was established. Systemic examinations were carried out in suspected cases. Early laparotomy was performed in high suspected cases. (2) If the diagnosis was uncertain at operation, pancreatic wedge biopsy or exploratory ducdenotomy and Oddi sphincterotomy were performed to reduce the percentage of missed diagnosis. Missed diagnosis in the first period was 8.8%, in the second period nil.(3) Staged operations were done in 30 deeply jaundiced patients in the second period. The mortality rate and postoperative complications with one stage operation were 21% and 57.8% respectively, while with staged operation, they were 10% and 30% respectively. (4) Extended regional pancreatectomy was done, including total extirpation of the peripancreatic lymph nodes together with the surrounding connective tissues. Resection and graft replacement or end to end anastomosis of portal and superior mesenteric vein was performed if necessary. 本文报告1962~1982年216例胰腺及壶腹区癌肿外科治疗的结果。第一阶段(1962~1977年)114例,第二阶段(1978~1982年)102例。早期病例(Hermreck Ⅰ期)在一、二阶段分别为8.8%及19.6%;胰头癌手术切除率分别为25.6%及37.7%;其1年生存率分别为50%及61%,3年生存率为8.3%及15.3%,5年生存率为0%及11.1%。各阶段效果进展的原因有:①成立专题门诊及病房,对可疑病例及时作有关检查。②手术中对怀疑病例主张作楔形活检,必要时切开十二指肠或Oddi括约肌检查。第一阶段手术误诊率为8.8%,而第二阶段无误诊。③第二阶段对黄疸较深者作分期手术30例。一期手术死亡率为21%,并发症为57.8%,分期手术死亡率为10%,并发症为30%。④手术方式采取扩大的区域性胰十二指肠切除术,清除胰腺,第一、二站的淋巴结及脂肪结缔组织,必要时作门静脉或肠系膜上静脉切除移植或吻合术。 Bronchoplastic lobectomy is a kind of operative method which can treat benign or malignant bronchial lesion of the lung. The bronchus is finally reconstructed. 6 cases are reported in this paper. The operative indications, techniques and post-operative care are also discussed. 支气管成形肺叶切除术是一种治疗支气管及肺部良性或恶性疾患并对病变支气管作袖式或楔形切除,然后重建支气管通道的手术方法。本文报道6例,并对诊断、手术方法、适应证及术后处理等进行了讨论。 The inflammatory pseudotumor in the lung is an inflammatory hyperplastic tumor-like affection. From 1980 to 1986, 340 cases of pneumonectomy were perform- ed in our hospital of which 13 cases of inflammatory pseudotumor were confirmed by pathology. In recent years the incidence of this disease grows. Seven cases in this group were seen during the last six months. The disease mimicks lung cancer. Among these 13 cases, 9 had haemoptysis and 8 had pain in the chest. X-ray exam- inations revealed isolated focus.... The inflammatory pseudotumor in the lung is an inflammatory hyperplastic tumor-like affection. From 1980 to 1986, 340 cases of pneumonectomy were perform- ed in our hospital of which 13 cases of inflammatory pseudotumor were confirmed by pathology. In recent years the incidence of this disease grows. Seven cases in this group were seen during the last six months. The disease mimicks lung cancer. Among these 13 cases, 9 had haemoptysis and 8 had pain in the chest. X-ray exam- inations revealed isolated focus. Clinical diagnosis is difficult, none of this group was diagnosed correctly before operation. The disease may occur at any age with mild symptom and prolonged course which is different from lung cancer. During the operation, a frozen section must be taken to confirm the diagnosis and efforts should be made to preserve lung tissue as much as possible. As a rule, cuneiform re- moval of segment of lung or a lobectomy, if necessory, is done. The cause of inflam- matory pseudotumor is not yet clear and few recurrence occurred after resection. 肺部炎性假瘤是肺实质内一种少见的炎性增生性肿瘤样病变,术前诊断困难。我院1980~1986年340例肺周边型病灶的肺切除中发现13例,但近6个月来就有7例,发病率似有增高趋势。13例中,咳嗽痰中带血9例,胸痛8例,X线表现为孤立的圆形或椭圆形肿块影,术前与肺癌鉴别较难,但本病可发生在任何年龄,症状轻,病程长与肺癌不同。手术中应做冰冻切片,证实为本病者,手术尽量保留肺组织,楔形、肺段切除或肺叶切除。本病病因尚不清楚,术后很少复发。
|