Moossa A R
Cancer. 1982 Dec 1;50(11 Suppl):2689-98.
The physician must suspect pancreatic cancer in patients older than age 40 years who present with minimal vague symptoms. The presence of common disorders such as gallstones, hiatal hernia and diverticulosis coli, does not exclude pancreatic cancer. Ultrasonography, computed tomography, ERCP and cytology are the essential diagnostic tools. Angiography delineates anatomic variations of the foregut vasculature and detects nonresectability of some tumors. Percutaneous fine needle aspiration of pancreatic masses for cytologic examination is recommended for lesions of the body and tail. Percutaneous transhepatic biliary drainage is advised preoperatively in patients whose serum bilirubin exceeds 20 mg/dl. Total pancreatoduodenectomy is recommended for all resectable pancreatic cancers. Surgical palliative procedures include biliary bypass, duodenal bypass and celiac plexus nerve block. Currently, only 30% of all pancreatic cancers seen are resectable and they are confined to the head of the pancreas. About 10% of all pancreatic cancers are potentially curable at the time of presentation. The operative mortality should be under 10%.
对于40岁以上出现轻微模糊症状的患者，医生必须怀疑胰腺癌。存在胆结石、食管裂孔疝和结肠憩室病等常见疾病并不排除胰腺癌。超声检查、计算机断层扫描、内镜逆行胰胆管造影（ERCP）和细胞学检查是重要的诊断工具。血管造影可描绘前肠血管系统的解剖变异，并检测某些肿瘤的不可切除性。对于胰体和胰尾病变，建议进行经皮细针穿刺胰腺肿块进行细胞学检查。血清胆红素超过20mg/dl的患者，术前建议行经皮经肝胆道引流。所有可切除的胰腺癌均建议行胰十二指肠切除术。手术姑息性操作包括胆道旁路术、十二指肠旁路术和腹腔神经丛阻滞。目前，所有胰腺癌患者中只有30%可切除，且这些肿瘤局限于胰头。所有胰腺癌患者中约10%在就诊时可能治愈。手术死亡率应低于10%。
