不断提高我国胰腺癌诊治规范化水平  

Fostering standardization of diagnosis and treatment of pancreatic cancer in China

作　　者：郑树森[1] 

机构地区：[1]浙江大学附属第一医院,杭州310003

出　　处：《中华普外科手术学杂志（电子版）》2013年第3期1-3,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：973计划项目(2003CB5500);(2009CB522400);国家科技重大专项课题(2008ZX10002-026);国家自然科学基金重点项目(30730085/C030205);国家自然科学基金创新群体(81121002/H1006)

摘　　要：胰腺癌早期缺乏特异性临床表现,诊断困难。对于进行性上腹不适、脂肪泻和新发糖尿病的患者,应行胰腺增强CT和肿瘤标志物筛查。发现可疑胰腺肿块,建议超声内镜,内镜逆行胰胆管造影(ERCP)胰液肿瘤标志物、脱落细胞和K-ras基因突变检测,甚至穿刺活检,以提高胰腺癌的早期诊断率。胰头癌侵犯门静脉/肠系膜上静脉时,主张整块(en-block)切除后行血管端端吻合、自体血管或异体血管重建;对于肠系膜上动脉受累,可切除后以自体大隐静脉重建。胰腺癌临床诊治困难,预后不佳。如何早期诊断和规范化治疗是改善胰腺癌预后的关键,提倡胰腺癌以外科手术为主的多学科协作的综合治疗模式(MDT),不断提高我国胰腺癌诊治规范化水平。Early diagnosis of pancreatic cancer is difficult, since the lack of specific clinical manifestations. Patients who have complaints of progressive epigastric discomfort, steatorrhea, and new set diabetes should receive enhanced CT scan of the pancreas and screening of tumor markers. If there is a suspicious pancreatic mass, further endoscopic ultrasonography, ERCP （pancreatic juice tumor markers, exfoliated cells and K-ras gene mutation） , even biopsy are suggested. When the portal/superior mesenteric vein is involved by pancreatic head cancer, en-block resection can be feasible with end-to-end anastomosis of the portal vein and reconstruction of autogenic or allogenic vessels. When the superior mesenteric artery is involved, the great saphenous vein can be used for interposition. Multi-disciplinary comprehensive treatment predominated by surgery has become the main trend in the treatment of pancreatic cancer.

关 键 词：胰腺肿瘤 诊断 规范 治疗学 

分 类 号：R735.9[医药卫生—肿瘤]