Hyöty M K, Nordback I H
Department of Surgery, University Central Hospital of Tampere, Finland.
Acta Chir Scand. 1990 May;156(5):391-6.
To investigate the effects of surgical and non-surgical palliation of jaundice in unresectable pancreatic carcinoma this retrospective study was performed. Between 1980 and 1983 90 patients were treated of whom 54 (69%) were jaundiced. Of these 36 were treated with biliary bypass (67%), four underwent resection (7%), five were treated by percutaneous drainage (9%) and nine (17%) were in such poor general condition that no treatment for jaundice was possible. Ninety-eight patients were treated between 1984 and 1987 when the initial approach to palliation of jaundice was endoscopic stenting. Transhepatic drainage was used only if stenting failed, and operation only if both non-surgical methods failed. Seventy-two of the 98 patients (73%) were jaundiced, of whom 18 (25%) received a stent placed endoscopically, 11 (15%) underwent transhepatic drainage, 27 (38%) underwent biliary bypass, and 14 (19%) underwent pancreatic resection. Significantly fewer patients in the second group could not be treated because of their poor general condition (n = 2, 3%, p less than 0.02). There were no differences among the methods in overall and 30 day complication rates, or the length of hospital stay, but the late complication rate was 1/63 (2%) for biliary bypass compared with 7/29 (24%) for biliary stenting (p less than 0.001). The difference was because of the high incidence of blockage of the stents causing recurrent jaundice, but the stents could easily be replaced. There was no difference in mortality between the two periods. We conclude that stenting is an acceptable alternative to biliary decompression in the treatment of obstructive jaundice in unresectable pancreatic cancer.
为研究不可切除胰腺癌黄疸的手术及非手术姑息治疗效果，开展了此项回顾性研究。1980年至1983年间，共治疗90例患者，其中54例（69%）出现黄疸。这些患者中，36例行胆肠吻合术（67%），4例行切除术（7%），5例行经皮引流术（9%），9例（17%）全身状况极差，无法进行黄疸治疗。1984年至1987年间，共治疗98例患者，此时黄疸姑息治疗的初始方法为内镜支架置入。仅在支架置入失败时采用经肝引流，仅在两种非手术方法均失败时才进行手术。98例患者中有72例（73%）出现黄疸，其中18例（25%）接受内镜下支架置入，11例（15%）行经肝引流，27例（38%）行胆肠吻合术，14例（19%）行胰腺切除术。第二组中因全身状况差无法治疗的患者明显较少（n = 2，3%，p < 0.02）。各治疗方法在总体并发症率、30天并发症率及住院时间方面无差异，但胆肠吻合术的晚期并发症率为1/63（2%），而胆管支架置入术为7/29（24%）（p < 0.001）。差异原因在于支架堵塞导致复发性黄疸的发生率较高，但支架可轻松更换。两个时期的死亡率无差异。我们得出结论，在不可切除胰腺癌所致梗阻性黄疸的治疗中，支架置入术是胆肠减压术的可接受替代方法。
