McGrath P C, McNeill P M, Neifeld J P, Bear H D, Parker G A, Turner M A, Horsley J S, Lawrence W
Department of Surgery, Medical College of Virginia, Richmond.
Ann Surg. 1989 Mar;209(3):284-8. doi: 10.1097/00000658-198903000-00006.
Clinical and pathologic data from 73 patients with unresectable carcinoma of the pancreas treated from 1980 to 1987 were reviewed to evaluate the efficacy of biliary enteric bypass and percutaneous transhepatic biliary drainage (PTBD) in the treatment of malignant biliary obstruction. Fifty-two patients underwent biliary enteric bypass with no operative deaths and with a 15% operative morbidity. These patients had a median postoperative hospitalization of 12 days. Four patients (8%) eventually developed recurrent jaundice, and three of these were successfully treated with PTBD. The median survival for these 52 patients was 7 months. Twenty-one patients underwent PTBD with an 81% technical-success rate. These patients had a 33% early complication rate and a 33% in-hospital mortality. The median hospitalization was 13 days postdrainage. Of the 14 patients surviving the initial hospitalization, 86% developed late complications requiring 16 hospital admissions and ten emergency room visits for a total of 155 days of hospitalization. The median survival for those patients undergoing PTBD was 4 months from the time of diagnosis and 2 months from the time of catheter drainage. Surgical bypass offers excellent palliation for malignant biliary obstruction with extremely low morbidity and mortality in properly selected patients; PTBD is useful in the treatment of those patients with extensive disease, who are poor surgical candidates, or who have failed previous surgical drainage. There is a role for both of these palliative procedures in the management of patients with biliary obstruction from pancreatic cancer.
回顾了1980年至1987年期间接受治疗的73例无法切除的胰腺癌患者的临床和病理资料，以评估胆肠吻合术和经皮肝穿刺胆道引流术（PTBD）治疗恶性胆道梗阻的疗效。52例患者接受了胆肠吻合术，无手术死亡，手术并发症发生率为15%。这些患者术后中位住院时间为12天。4例患者（8%）最终出现复发性黄疸，其中3例经PTBD成功治疗。这52例患者的中位生存期为7个月。21例患者接受了PTBD，技术成功率为81%。这些患者早期并发症发生率为33%，住院死亡率为33%。引流术后中位住院时间为13天。在最初住院存活的14例患者中，86%出现晚期并发症，需要住院16次，急诊就诊10次，总共住院155天。接受PTBD的患者从诊断时起的中位生存期为4个月，从置管引流时起为2个月。对于恶性胆道梗阻，在适当选择的患者中，手术旁路提供了极佳的姑息治疗，发病率和死亡率极低；PTBD可用于治疗那些病情广泛、手术候选性差或先前手术引流失败的患者。这两种姑息性手术在胰腺癌所致胆道梗阻患者的治疗中都有作用。
