老年胰十二指肠切除术经验体会作者空军总医院肝胆外科徐新保摘要：目的总结65岁以上老年患者施行胰十二指肠切除术的经验体会。
方法回顾性分析我院1994年至2009年收治的39例65岁以上患者胰十二指肠切除术的资料。
结果术前减黄7例，1例术前减黄仅1d者术后死亡，6例术前减黄10d以上者术后均康复。
手术后近期死亡4例，2例死于肝功能衰竭，2例死于胰漏及胆漏导致的多器官衰竭。
18例发生一种或多种并发症，其中消化道出血6例，胰漏6例，胆漏3例，肠漏2例，肺部感染3例，ARDS（急性呼吸窘迫综合征）1例，腹腔感染4例，切口感染2例，均经积极治疗痊愈。
术后因消化道大出血、腹腔出血和胰漏等再手术3例，术后均逐渐康复。
术后1、3及5a存活率分别为68.57% (24/35)、27.59% (8/29)、11.11% (3/27)。
结论高龄患者只要术前心肺肝肾等主要器官功能尚可，即可手术，总体上疗效满意。
关键词：胰腺肿瘤；壶腹周围肿瘤；老年患者；胰十二指肠切除术Experience on pancreaticoduodenectomy for periampullary cancer and pancreatic malignant neoplasm in the aged patientsAbstract: Objective To outline the clinical experience of pancreaticoduodenectomy(PD) for periampullary cancer and pancreatic malignant neoplasm in patients more than 65 years in age. Methods Thirty-nine patients more than 65 years old undergone PD in our hospital from 1994 to 2009 were analyzed retrospectively. Results6 of 7 cases undergone preoperative biliary drainage (PBD) more than 10 days were recovered afterPD and 1 case undergone PBD only for one day died of the operation. Of the 39 patients, 2 died of liver failure and 2 died of multiple organ failure due to pancreatic leakage and bile leakage shortly after operation; 18 developed one or more kind of postoperative complications, including hemorrhage of digestive tract in 6, pancreatic leakage in 6, bile leakage in 3, intestinal leakage in 2, pulmonary infection in 3, acute respiratory distress syndrome(ARDS) in 1, abdominal infection in 3, postoperative infection of skin incision in 2 cases, all of them were fully recovered by active medical treatment. 3 cases undergone reoperation because of massive hemorrhage of gastrointestinal tract and peritoneal cavity and severe pancreatic leakage. Postoperative survival rates of 1, 3 and 5 year(s) were respective 68.57%(24/35), 27.59%(8/29),11.11%(3/27). Conclusion If the main organs’ (the heart, lung, liver, kidney, etc) function acceptable, PD can be performed in the aged patients and gain satisfactory therapeutic effect.【Key words】pancreatic neoplasm; periampullary carcinoma; senility; pancreaticoduodenectomy随着人类寿命延长及癌症发生率增高，高龄壶腹周围肿瘤患者逐渐增多。
