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A Clinical Review on Whipples Operation for Carcinoma of Pancreaticoduodenal Area

ѿܰȸ 1969 11 2ȣ p.151 ~ 157
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The hospital records of all patients admitted to Pusan University Hospital from 1962 to 1968, undergoing panceaticoduodenectomy and palliative bilary-intestinal bypass procedures (62 cases) have been reviewed. Following an analysis of the surgical and pathological reports, a total of 28 patients who had panceaticoduodenectomy and bypass procedures was selected for further stude.
The average age of the 18 men and 10 women was 55 years. The median duration of the symptoms was 3 months. Jaundice, pain, weight loss and dyspepsia were the most common complaints. On physical examination half the patients had enlarged livers, and enlarged gallbladder could be palpated in 60% of the patients. In those patients who were jaundiced the direct and indirect bilirubin and alkaline phosphatase figures were abnormally high.
Histological examination of material obtained at operation revealed 18 cases of adenocarcinoma of the distal common bile duct, 3 cases of adenocarcinoma of the ampulla of Vater, 5 cases of adnocarcinoma of the pancreas head, and 2 cases of stomach carcinoma. One stage panceaticoduodenectomy was performedon 6 cases, who had adenocarcinoma of the distal commonbile duct, ampulla of Vater, and stomach (one panceaticoduodenectomy and transeverse colectomy among those). Two stage procedure was done on 5 patients who had adenocarcinoma of the distal common bile duct. Among palliatives biliary-intestinal bypass procedures cholecystojejunostomy was performed on 7 cases and hepatojejunostomy on 8 cases. After these radical procedures the average survival time was 14.6 months. Among bypass procedures average survival time after cholecystojejunostomy and hepatojejunostomy was 11.4 months and 7.4 months respectively. There were two deaths among the 11 panceaticoduodenectomy cases giving a mortality rate of 8.1%.