Spinelli P, Schicchi A A, Schiavo M
Divisione di Diagnostica e Chirurgia Endoscopica, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italia.
Tumori. 1999 Jan-Feb;85(1 Suppl 1):S60-3.
The incidence of pancreatic cancer continues to increase and, although improving of diagnostic techniques, the prognosis is very poor with 5-year survival less than 5% and high mortality cancer rate. Neural and lymphatic micrometastases appear in early stages and curative resection is possible in few selected cases; in these patients there is a high local recurrence rate and a low median survival. Most patients with pancreatic cancer need palliative care of the obstructive jaundice (90%), duodenal stenosis and abdominal pain; endoscopic procedures have an important role in the treatment of these patients. Endoscopic placement of plastic biliary stents is a safe and efficient technique to perform a biliary drainage with a short hospital stay. The use of metal stent, instead of plastic prosthesis, improve median patency of the prosthesis with a low incidence of cholangitis, but they should be used only in patients with a life expectancy of more than six months, because of their high costs. Laparoscopic gastro-entero-anastomosis is a valid alternative to laparotomic procedure in the treatment of the duodenal stenosis, with a shorter hospital stay and a lower morbidity rate. The endoscopic treatment of abdominal pain with pancreatic endoprosthesis placement or with endosonography-guided celiac plexus neurolysis is an alternative approach to radiotherapy and analgesic drugs.
胰腺癌的发病率持续上升，尽管诊断技术有所改进，但预后仍然很差，5年生存率低于5%，死亡率很高。神经和淋巴微转移在疾病早期就会出现，只有少数特定病例能够进行根治性切除；这些患者局部复发率高，中位生存期短。大多数胰腺癌患者需要对梗阻性黄疸（90%）、十二指肠狭窄和腹痛进行姑息治疗；内镜手术在这些患者的治疗中发挥着重要作用。内镜下放置塑料胆管支架是一种安全有效的胆管引流技术，住院时间短。使用金属支架而非塑料假体可提高假体的中位通畅时间，胆管炎发生率低，但由于成本高，仅应在预期寿命超过6个月的患者中使用。腹腔镜胃肠吻合术是治疗十二指肠狭窄的剖腹手术的有效替代方法，住院时间短，发病率低。通过放置胰腺内支架或内镜超声引导下腹腔神经丛松解术对腹痛进行内镜治疗是放疗和镇痛药的替代方法。
