Holbrook A G, Chester J F, Britton D C
Department of Surgery, Royal United Hospital, Bath.
J R Soc Med. 1990 Jan;83(1):12-4. doi: 10.1177/014107689008300107.
Because a number of options are available to relieve the obstructed bile duct, stomach or both in patients with irresectable carcinoma of the pancreatic head, palliative surgery for this condition was reviewed retrospectively between 1971 and 1981 at the Royal United Hospital, Bath. One hundred and sixty-five patients underwent a biliary bypass procedure with (n = 37), or without (n = 128) gastric drainage. Thirty patients had a prophylactic gastroenterostomy to avoid gastric outlet obstruction: tumour encroachment made gastroenterostomy essential in seven others. After biliary bypass alone, operative mortality was 14%. After a concomitant gastroenterostomy, mortality was 27% (P less than 0.04). Within a year of biliary bypass alone, there was a 9% incidence of gastric outlet obstruction requiring gastric drainage, with an associated mortality rate of 18%. Survival after biliary bypass or biliary bypass with gastroenterostomy was equal (7-8 months). Except where gastric outlet obstruction is imminent, palliation for irresectable pancreatic head carcinomas should be by biliary bypass alone, because the addition of a gastroenterostomy almost doubles the mortality without any advantage in survival time.
由于对于无法切除的胰头癌患者，有多种方法可用于缓解胆管、胃或两者的梗阻，因此于1971年至1981年在巴斯皇家联合医院对这种情况的姑息性手术进行了回顾性研究。165例患者接受了胆管搭桥手术，其中37例同时进行了胃引流，128例未进行胃引流。30例患者进行了预防性胃肠吻合术以避免胃出口梗阻：另外7例因肿瘤侵犯使胃肠吻合术成为必要。仅行胆管搭桥术后，手术死亡率为14%。同时进行胃肠吻合术后，死亡率为27%（P<0.04）。仅行胆管搭桥术后一年内，胃出口梗阻需要胃引流的发生率为9%，相关死亡率为18%。胆管搭桥或胆管搭桥加胃肠吻合术后的生存率相同（7 - 8个月）。除非胃出口梗阻迫在眉睫，无法切除的胰头癌的姑息治疗应仅采用胆管搭桥，因为增加胃肠吻合术几乎使死亡率加倍，而在生存时间上没有任何优势。
