Singh S M, Longmire W P, Reber H A
Department of Surgery, UCLA School of Medicine.
Ann Surg. 1990 Aug;212(2):132-9. doi: 10.1097/00000658-199008000-00003.
We reviewed the records of 340 patients with a tissue diagnosis of pancreatic cancer treated at UCLA Medical Center between 1973 and 1988. Sixty-one patients underwent pancreatic resection (group I), 173 had some form of surgical palliation (group II), and 106 had neither (group III). The diagnosis was made 1 to 2 months more quickly in the last 8 years of the review than in the first 8 years, but the effect of early diagnosis on curability was negligible. Biliary obstruction was best treated by cholecystojejunostomy or choledochojejunostomy, which were equally effective. Anastomoses to the jejunum were safer and more effective than were those to the duodenum for the relief of biliary obstruction. Gastrojejunostomy should be performed prophylactically as well as therapeutically. It was effective and safe in both settings. Surgical palliation for pancreatic cancer was generally effective and was associated with an operative mortality rate of less than 10%. However morbidity was high, with significant complications occurring in one third of cases.
我们回顾了1973年至1988年间在加州大学洛杉矶分校医学中心接受组织学诊断为胰腺癌的340例患者的病历。61例患者接受了胰腺切除术（第一组），173例接受了某种形式的手术姑息治疗（第二组），106例既未接受手术切除也未接受手术姑息治疗（第三组）。在回顾的最后8年中，诊断比前8年提前了1至2个月，但早期诊断对治愈率的影响微乎其微。胆管梗阻最好通过胆囊空肠吻合术或胆总管空肠吻合术治疗，这两种方法同样有效。对于缓解胆管梗阻，与十二指肠吻合相比，与空肠吻合更安全、更有效。胃空肠吻合术应在预防性和治疗性情况下都进行。在这两种情况下，它都是有效且安全的。胰腺癌的手术姑息治疗总体上是有效的，手术死亡率低于10%。然而，发病率很高，三分之一的病例出现了严重并发症。
