Gough I R, Mumme G
J Surg Oncol. 1984 Aug;26(4):282-4. doi: 10.1002/jso.2930260416.
A review was undertaken of 66 patients having palliative bypass surgery for carcinoma of the head of the pancreas. A second laparotomy for relief of duodenal obstruction was necessary in six of 29 (20%) of the patients who did not have gastroenterostomy performed initially, but late gastric outlet obstruction occurred only once in 37 patients having an initial gastroenterostomy (P less than 0.05). Cholecystojejunostomy failed to provide permanent biliary bypass in 14 of 53 (26%) patients, compared to successful drainage in all 13 patients having anastomosis of the common hepatic duct to the jejunum (P less than 0.05). In seven patients cholecystojejunostomy was performed when the cystic duct was already obstructed by tumour. Therefore prophylactic gastrojejunostomy is recommended as a routine. The gallbladder should only be used for biliary bypass when appropriate contrast x-rays have demonstrated the patency of the cystic duct.
对66例因胰头癌接受姑息性搭桥手术的患者进行了回顾性研究。在最初未行胃肠吻合术的29例患者中，有6例（20%）需要再次剖腹手术以缓解十二指肠梗阻，但在最初行胃肠吻合术的37例患者中，晚期胃出口梗阻仅发生1次（P<0.05）。在53例患者中，有14例（26%）的胆囊空肠吻合术未能提供永久性胆道搭桥，而在所有13例行肝总管与空肠吻合术的患者中均成功引流（P<0.05）。在7例患者中，当胆囊管已被肿瘤阻塞时进行了胆囊空肠吻合术。因此，建议常规进行预防性胃肠吻合术。只有在适当的造影X线显示胆囊管通畅时，胆囊才能用于胆道搭桥。
