Kuriansky J, Sáenz A, Astudillo E, Cardona V, Fernández-Cruz L
Department of Surgery, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170,08036 Barcelona, Spain.
Surg Endosc. 2000 Feb;14(2):179-81. doi: 10.1007/s004649900095.
A substantial number of patients with unresectable pancreatic cancer eventually develop biliary or gastric outlet obstruction. In some cases, they present initially with both complications. These conditions contribute markedly to their discomfort and certainly justify palliative intervention. The purpose of this study was to examine the feasibility and safety of simultaneous laparoscopic biliary and gastric bypass in patients with unresectable carcinoma of the pancreas.
Between August 1995 and July 1998, simultaneous laparoscopic biliary and retrocolic gastric bypass was performed successfully in 12 consecutive patients with unresectable carcinoma of the pancreas. There were eight men and four women. Their median age was 72 years (range, 50-82). In all patients, the indications for gastrointestinal bypass were gastric outlet obstruction and obstructive jaundice. The following parameters were evaluated for each patient: procedure-related morbidity and mortality, operative time, length of hospital stay, overall survival, and ability to sustain oral nutrition during the survival period.
All procedures were completed laparoscopically. The mean operative time was 89 +/- 29.56 min. There were no intraoperative complications. Postoperative morbidity consisted of wound infection in two patients and pneumonia in one patient. One patient died of multiorgan failure on postoperative day 2. The mean hospital stay was 6.4 +/- 1.5 days (range, 5-17). The mean survival time until death from underlying disease was 85 +/- 32. 46 days (range, 31-260). None of the patients had recurrent jaundice, and all of them were able to maintain oral nutrition.
Simultaneous laparoscopic biliary and retrocolic gastric bypass is a safe and effective technique for the treatment of biliary and gastroduodenal obstruction in patients with unresectable pancreatic cancer.
大量无法切除的胰腺癌患者最终会出现胆道或胃出口梗阻。在某些情况下，他们最初会同时出现这两种并发症。这些情况显著增加了患者的不适，当然也证明了姑息性干预的合理性。本研究的目的是探讨在无法切除的胰腺癌患者中同时进行腹腔镜胆道和胃旁路手术的可行性和安全性。
1995年8月至1998年7月，连续12例无法切除的胰腺癌患者成功接受了腹腔镜胆道和结肠后胃旁路联合手术。其中男性8例，女性4例。他们的中位年龄为72岁（范围50 - 82岁）。所有患者进行胃肠道旁路手术的指征均为胃出口梗阻和梗阻性黄疸。对每位患者评估以下参数：与手术相关的发病率和死亡率、手术时间、住院时间、总生存期以及生存期内维持口服营养的能力。
所有手术均通过腹腔镜完成。平均手术时间为89±29.56分钟。术中无并发症。术后并发症包括2例伤口感染和1例肺炎。1例患者术后第2天死于多器官功能衰竭。平均住院时间为6.4±1.5天（范围5 - 17天）。因基础疾病死亡的平均生存时间为85±32.46天（范围31 - 260天）。所有患者均未出现复发性黄疸，且均能够维持口服营养。
同时进行腹腔镜胆道和结肠后胃旁路手术是治疗无法切除的胰腺癌患者胆道和胃十二指肠梗阻的一种安全有效的技术。
