Shils M E
Cancer Res. 1977 Jul;37(7 Pt 2):2387-94.
Carcinoma of the pancreas is increasing in the United States and has a grave progonosis. Surgical treatment has moved from subtotal pancreatectomy to total pancreatectomy and now to en bloc resection and vascular replacement. Pancreatic exocrine and endocrine insufficiency following resection add to the nutritional problems presented by this major surgery and its high complication rate. Recognition of these problems and adequate treatment decrease morbidity and mortality. Major hepatic resection imposes metabolic problems in the immediate postoperative period that are minimized by improving preoperative nutritional status and by providing adequate postoperative support with albumin and carbohydrate. Urinary tract diversion for pelvic cancer involving the ureters and/or bladder has progressed from ureterosigmoidostomy with its high incidence of disturbances of electrolyte and acid-base balance to ureteroileostomy with its appreciably lower rate of complications.
在美国，胰腺癌的发病率正在上升，且预后严重。手术治疗已从胰腺次全切除术发展到全胰腺切除术，现在又发展到整块切除和血管置换。切除术后胰腺外分泌和内分泌功能不全加重了这种大手术及其高并发症率所带来的营养问题。认识到这些问题并进行适当治疗可降低发病率和死亡率。主要的肝脏切除术在术后即刻会带来代谢问题，通过改善术前营养状况以及术后给予白蛋白和碳水化合物进行充分支持，这些问题可减至最低程度。涉及输尿管和/或膀胱的盆腔癌的尿路改道术已从电解质和酸碱平衡紊乱发生率高的输尿管乙状结肠吻合术发展到并发症发生率明显较低的输尿管回肠吻合术。
