不合并消化道梗阻的晚期胰头癌441例临床诊治分析  

Management of inoperable advanced pancreatic head carcinoma without gastric outlet obstruction： an analysis of 441 patients

作　　者：杨冲[1] 王博[1] 李永峰[1] 勾善淼[1] 王春友[1] 吴河水[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院胰腺病研究所,武汉430022

出　　处：《中华普通外科杂志》2013年第5期347-350,共4页Chinese Journal of General Surgery

基　　金：基金项目：卫生部行业科研专项项目（201202007）

摘　　要：目的分析不合并消化道梗阻的晚期胰头癌的临床资料，探讨治疗策略。方法回顾性分析2001年1月至2010年12月收治的441例不伴消化道梗阻的晚期胰头癌患者的临床资料。结果所有患者均行手术治疗，其中行胆囊-空肠Roux-en-Y吻合术（A组）101例，胆总管-空肠Roux-en-Y吻合术（B组）133例，胆囊-空肠Roux-en-Y吻合＋胃-空肠吻合术（C组）83例，胆总管-空肠Roux-en-Y吻合＋胃-空肠吻合术（13组）124例。术后A、C两组分别有7．9％及6．0％的患者再发胆道梗阻，A、B两组分别有8．9％及8．3％的患者出现消化道梗阻，四组患者生存时间差异无统计学意义（F=1．933，P=0．123）。结论对不合并消化道梗阻的晚期胰头癌患者，胆总管空肠吻合术能有效预防术后再次胆道梗阻；预防性胃空肠吻合术能显著降低患者术后消化道梗阻发生率，而胆囊．空肠吻合术仅可在患者一般情况较差或胆管吻合条件不具备时谨慎选用。Objective To explore the optimal management strategies for unresectable advanced pancreatic head carcinoma without preoperative gastric outlet obstruction （ GOO ）. Methods Clinical data of 441 cases of advanced pancreatic head carcinoma without GOO undergoing surgery from Jan 2001 to Dec 2010 were analyzed retrospectively. Results Among the 441 cases of advanced pancreatic head carcinoma without GOO, 101 patients received simple Roux-en-Y cholecystojejunostomy （group A）, 133 patients received simple Roux-en-Y choledochojejunostomy （group B ）, 83 patients received Roux-en-Y cholecystojejunostomy combined gastrojejunostomy（ group C） and the other 124 patients received Roux-en-Y choledochojejunostomy combined gastrojejunostomy （group D ）. The postoperative recurrent obstructive jaundice rates were 7. 9% and 6. 0% in group A and C, respectively; the postoperative de novo GOO rates were 8.9% and 8.3% in group A and B, respectively; there were no differences in median survivals among the four groups （ F = 1. 933, P = 0. 123 ）. Conclusions Choledochojejunostomy is effective for the reduction of recurrent obstructive jaundice for advanced pancreatic head carcinoma patients without GO0, combined prophylactic gastrojejunostomy during surgical biliary drainage could decrease the rate of postoperative GOO. Cholecystojejunostomy could be only applied for patients with poor health or when choledochojejunostomy is a taboo.

关 键 词：胰腺肿瘤 吻合术 外科 胆总管造口术 

分 类 号：R735[医药卫生—肿瘤]