Lucas C E, Ledgerwood A M, Bender J S
Department of Surgery, Wayne State University, Detroit, MI 48201.
Surgery. 1991 Oct;110(4):583-9; discussion 589-90.
The traditional approach to gastric outlet obstruction caused by unresectable pancreatic cancer is gastrojejunostomy performed during or after biliary bypass surgery. Previous work showed that gastrojejunostomy failed in 95% of patients with preoperative outlet obstruction, which was evidenced by nausea and vomiting. This study defines a better bypass procedure, namely, antrectomy with gastrojejunostomy, which was performed in 19 such patients. The cancer was primary pancreatic in 17 patients and metastatic to the pancreas in two patients with a renal and urinary bladder primary. All patients had duodenal extension with impaired alimentation. Fourteen patients underwent simultaneous biliary bypass surgery and antrectomy with gastrojejunostomy; the antrectomy with gastrojejunostomy procedure was performed in five patients 3 weeks to 6 months after biliary bypass surgery when duodenal obstruction supervened. Visible cancer extended to the duodenal stump in five patients, including two patients whose partial closure was buttressed with omentum. All 19 patients tolerated regular diet at the time of discharge 1 to 4 weeks after the antrectomy with gastrojejunostomy procedure. All patients, who died at 4 to 21 months after surgery tolerated solid food until immediately before death. All nine surviving patients have taken solid foods 9 to 29 months since the antrectomy with gastrojejunostomy procedure. We conclude that the antrectomy with gastrojejunostomy procedure, whether performed simultaneously with or subsequently to biliary bypass surgery, is the best palliative procedure for duodenal obstruction in patients with unresectable pancreatic cancer.
对于无法切除的胰腺癌所致胃出口梗阻，传统的治疗方法是在胆道旁路手术期间或之后进行胃空肠吻合术。既往研究表明，95%的术前存在出口梗阻的患者胃空肠吻合术失败，表现为恶心和呕吐。本研究定义了一种更好的旁路手术，即胃窦切除术加胃空肠吻合术，对19例此类患者实施了该手术。17例患者的癌症原发于胰腺，2例患者的癌症原发于肾和膀胱，转移至胰腺。所有患者均有十二指肠受累且营养摄入受损。14例患者同时接受了胆道旁路手术和胃窦切除术加胃空肠吻合术；5例患者在胆道旁路手术后3周 至6个月出现十二指肠梗阻时接受了胃窦切除术加胃空肠吻合术。5例患者可见癌组织延伸至十二指肠残端，其中2例患者的部分残端闭合处用网膜加固。所有19例患者在接受胃窦切除术加胃空肠吻合术后1至4周出院时均能耐受正常饮食。所有在术后4至21个月死亡的患者直至临死前都能耐受固体食物。9例存活患者自接受胃窦切除术加胃空肠吻合术后9至29个月一直能进食固体食物。我们得出结论，胃窦切除术加胃空肠吻合术，无论与胆道旁路手术同时进行还是在其之后进行，都是无法切除的胰腺癌患者十二指肠梗阻的最佳姑息性手术。
