House Michael G, Choti Michael A
Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
Surg Clin North Am. 2005 Apr;85(2):359-71. doi: 10.1016/j.suc.2005.01.022.
Palliative treatment for unresectable periampullary cancer is directed at three major symptoms: obstructive jaundice, duodenal obstruction, and cancer-related pain. In most cases, the pattern of symptoms at the time of diagnosis in the context of the patient's medical condition and projected survival influence the decision to perform an operative versus a non operative palliative procedure. Despite improvements in preoperative imaging and laparoscopic staging of patients with periampullary cancer and hilar cholangiocarcinoma, surgical exploration is the only modality that can definitively rule out resectability and the potential for curative resection in some patients with nonmetastatic cancer. Furthermore, only surgical management achieves successful palliation of obstructive symptoms and cancer-related pain as a single procedure during exploration. To take advantage of the long-term advantages afforded by surgical palliation,operative procedures must be performed with acceptable morbidity. The average postoperative length of hospital stay for patients who undergo surgical palliation is less than 15 days, even in those who develop minor complications. The average survival of patients who receive surgical palliation alone for nonmetastatic, unresectable pancreatic cancer is approximately 8 months. As with all treatment planning, palliative therapy for pancreatic and biliary cancer should be planned using a multidisciplinary approach, including input from the surgeon, gastroenterologist, radiologist,and medical and radiation oncologist. In this way, quality of life can be optimized in most patients with these diseases.
梗阻性黄疸、十二指肠梗阻和癌痛。在大多数情况下，结合患者的病情和预计生存期，诊断时的症状模式会影响采取手术或非手术姑息治疗的决策。尽管壶腹周围癌和肝门胆管癌患者的术前影像学检查和腹腔镜分期有所改进，但手术探查是唯一能明确排除某些非转移性癌症患者的可切除性及根治性切除可能性的方法。此外，只有手术治疗能在探查过程中一次性成功缓解梗阻症状和癌痛。为利用手术姑息治疗带来的长期益处，手术操作的并发症发生率必须在可接受范围内。接受手术姑息治疗的患者术后平均住院时间少于15天，即使是出现轻微并发症的患者。仅接受手术姑息治疗的非转移性、不可切除胰腺癌患者的平均生存期约为8个月。与所有治疗方案一样，胰腺癌和胆管癌的姑息治疗应采用多学科方法制定，包括外科医生、胃肠病学家、放射科医生以及医学和放射肿瘤学家的意见。通过这种方式，大多数患有这些疾病的患者的生活质量可以得到优化。
