Schouten J T
Am J Surg. 1986 May;151(5):626-30. doi: 10.1016/0002-9610(86)90575-1.
The prognosis for patients with pancreatic adenocarcinoma remains dismal. The operative management of 116 patients with pancreatic adenocarcinoma treated over a 15 year period was reviewed. Biliary bypass was associated with a high operative mortality (33 percent). Cholecystojejunostomy was associated with a 27 percent incidence of recurrent obstructive jaundice before death. Therefore, it is recommended that when feasible, a choledochojejunostomy be performed. A 25 percent incidence of duodenal obstruction was observed in patients who did not routinely undergo prophylactic gastroenterostomy. Survival was short in all patients whether or not a resection was performed: the mean survival after biliary bypass was 5.6 months. A significant problem was observed in patients who underwent pancreaticoduodenectomy. Tumor was present at the line of transection of the pancreas in the majority of patients. Thus, it is strongly recommended that frozen section examination of the margin of the pancreas be carried out routinely if a partial pancreatectomy is performed. Newer techniques of palliation for patients with pancreatic carcinoma such as fine needle aspiration biopsy guided by computerized axial tomography and internal or external biliary stenting are encouraged due to the high operative mortality and short survival of all patients with pancreatic adenocarcinoma. There were no long-term survivors after radical pancreaticoduodenectomy in this series.
胰腺腺癌患者的预后仍然很差。回顾了15年间接受治疗的116例胰腺腺癌患者的手术治疗情况。胆肠吻合术的手术死亡率很高（33%）。胆囊空肠吻合术患者在死亡前复发性梗阻性黄疸的发生率为27%。因此，建议在可行的情况下，行胆总管空肠吻合术。未常规行预防性胃肠吻合术的患者十二指肠梗阻发生率为25%。无论是否进行切除，所有患者的生存期都很短：胆肠吻合术后的平均生存期为5.6个月。接受胰十二指肠切除术的患者存在一个重大问题。大多数患者胰腺横断面上有肿瘤。因此，如果进行部分胰腺切除术，强烈建议常规进行胰腺切缘的冰冻切片检查。由于所有胰腺腺癌患者手术死亡率高且生存期短，鼓励采用如计算机断层扫描引导下的细针穿刺活检以及内外胆管支架置入等胰腺癌患者的新姑息治疗技术。本系列中根治性胰十二指肠切除术后无长期存活者。
