Potts J R, Broughan T A, Hermann R E
Department of General Surgery, Cleveland Clinic Florida, Ft. Lauderdale 33309.
Am J Surg. 1990 Jan;159(1):72-7; discussion 77-8. doi: 10.1016/s0002-9610(05)80609-9.
Controversies in palliation of pancreatic carcinoma include the best biliary bypass, the best gastric by-pass, and how routinely gastric bypass should be used. We reviewed the records of 142 patients who underwent palliative operations for pancreatic carcinoma at the Cleveland Clinic over a 5-year period. Direct choledochal-enteric anastomosis proved superior to cholecystojejunostomy because of the high incidence of postoperative biliary sepsis and obstruction with the latter. The lowest incidence of these complications was achieved with choledochoduodenostomy. Loop gastrojejunostomy and Roux-Y gastrojejunostomy resulted in similar complication rates and postoperative stays, but, because loop reconstruction was simpler, it was deemed superior. Blood loss, operative time, and hospital stay were similar in patients with loop gastrojejunostomy and patients with no gastric bypass. This finding, coupled with a 10% incidence of subsequent gastric outlet obstruction in those without gastric bypass, indicates that gastric bypass should be liberally applied in the palliation of pancreatic carcinoma.
胰腺癌姑息治疗中的争议包括最佳的胆肠吻合术、最佳的胃肠吻合术以及胃肠吻合术的常规应用方式。我们回顾了克利夫兰诊所5年间142例行胰腺癌姑息手术患者的记录。由于胆囊空肠吻合术后胆系感染和梗阻发生率高，胆总管空肠直接吻合术被证明优于胆囊空肠吻合术。胆总管十二指肠吻合术并发症发生率最低。袢式胃空肠吻合术和Roux-Y胃空肠吻合术并发症发生率和术后住院时间相似，但由于袢式重建更简单，故认为其更优。袢式胃空肠吻合术患者与未行胃肠吻合术患者的失血量、手术时间和住院时间相似。这一发现，再加上未行胃肠吻合术患者随后发生胃出口梗阻的发生率为10%，表明胃肠吻合术应广泛应用于胰腺癌的姑息治疗。
