Giraudo G, Kazemier G, Van Eijck C H, Bonjer H J
Department of Surgery, University Hospital Dijkzigt, Rotterdam, The Netherlands.
Ann Oncol. 1999;10 Suppl 4:278-80.
Evaluation of thoracoscopic splanchnicectomy and laparoscopic gastrojejunostomy as endoscopic palliative treatment of advanced pancreatic cancer.
Between November 1993 and September 1998 we performed 16 thoracoscopic splanchnicectomies and 6 laparoscopic gastrojejunostomies in patients with an advanced pancreatic cancer admitted to the Department of Surgery of University Hospital Rotterdam-Dijkzigt. These patients either did not achieve adequate pain control with medication or presented serious problems of gastric outlet obstruction, or both.
There were fourteen patients (9 men and 5 women) with mean age of 51.8 years (range 28-83), mean BMI of 21.1 (range 17.2-27.2), ASA score I in 2, II in 11, III in 1. We performed 2 left, 2 right and 4 bilateral thoracoscopic splanchnicectomies, 4 laparoscopic gastrojejunostomies and 2 combined endoscopic procedures (bilateral thoracoscopic splanchnicectomy and laparoscopic gastrojejunostomy). The overall average operation ("skin to skin") time was 86 minutes (range 75-100) for bilateral thoracoscopic splanchnicectomies, 63 minutes (range 60-65) for unilateral splanchnicectomies, 88 minutes (range 65-115) for laparoscopic gastrojejunostomies and 190 minutes (range 180-200) for the combined procedure. Blood loss was insignificant with a median of 50 ml (range 30-150). The conversion's rate to open surgery was 4.5%. There were no intraoperative complications. The overall average postoperative mobilization was in 1.9 days (range 1-4) and the overall median postoperative hospital stay was 7 days (range 2-24). There was no mortality at 30 days after endoscopic procedures and the morbidity rate was 21.4%. The postoperative analgesic requirement was considerably reduced with a successful rate was 83.3%. The resolution of gastric outlet obstruction has been complete in all laparoscopic gastrojejunostomies.
Our results show the feasibility and safety of these minimally invasive approaches such as endoscopic palliative treatment of complications of advanced pancreatic cancer.
评估胸腔镜内脏神经切除术和腹腔镜胃空肠吻合术作为晚期胰腺癌的内镜姑息治疗方法。
1993年11月至1998年9月期间，我们对鹿特丹-迪克齐赫特大学医院外科收治的晚期胰腺癌患者进行了16例胸腔镜内脏神经切除术和6例腹腔镜胃空肠吻合术。这些患者要么药物止痛效果不佳，要么存在严重的胃出口梗阻问题，或者两者皆有。
14例患者（9例男性和5例女性），平均年龄51.8岁（范围28 - 83岁），平均体重指数21.1（范围17.2 - 27.2），美国麻醉医师协会（ASA）评分：I级2例，II级11例，III级1例。我们进行了2例左侧、2例右侧和4例双侧胸腔镜内脏神经切除术，4例腹腔镜胃空肠吻合术以及2例联合内镜手术（双侧胸腔镜内脏神经切除术和腹腔镜胃空肠吻合术）。双侧胸腔镜内脏神经切除术的总体平均手术（“皮肤到皮肤”）时间为86分钟（范围75 - 100分钟），单侧内脏神经切除术为63分钟（范围60 - 65分钟），腹腔镜胃空肠吻合术为88分钟（范围65 - 115分钟），联合手术为190分钟（范围180 - 200分钟）。失血量极少，中位数为50毫升（范围30 - 150毫升）。转为开放手术的比例为4.5%。无术中并发症。总体平均术后活动时间为1.9天（范围1 - 4天），术后住院时间中位数为7天（范围2 - 24天）。内镜手术后30天无死亡病例，发病率为21.4%。术后镇痛需求显著减少，成功率为83.3%。所有腹腔镜胃空肠吻合术均完全解除了胃出口梗阻。
我们的结果表明，这些微创方法如晚期胰腺癌并发症的内镜姑息治疗具有可行性和安全性。
