Egrari S, O'Connell T X
Kaiser Permanente Medical Center, Los Angeles, California 90027, USA.
Am Surg. 1995 Oct;61(10):862-4.
Methods of palliation and the use of prophylactic gastroenterostomy in the treatment of unresectable pancreatic carcinoma remain controversial. Gastroenterostomy has been linked with various complications. We conducted a 10-year (1982-1992) retrospective review of patients who had unresectable pancreatic carcinoma and underwent biliary decompression without prophylactic gastroenterostomy. 50 patients were studied. Only four patients (8%) developed duodenal obstruction and required reoperation for therapeutic gastroenterostomy. The mean time to obstruction was 15.75 months, whereas the mean overall survival was 12.99 months. The mean survival of patients who underwent therapeutic gastroenterostomy was 32.25 months, with an average palliation of 16.5 months after the second operation. We conclude that pancreatic carcinoma has a rapid natural progression, and most patients do not survive long enough to obstruct. The ones who do obstruct are unique in that they survive for a long period of time. We recommend that routine prophylactic gastroenterostomy is unnecessary, and selective use of gastroenterostomy should be exercised in case of present or impending duodenal obstruction.
姑息治疗方法以及预防性胃肠造口术在不可切除胰腺癌治疗中的应用仍存在争议。胃肠造口术与多种并发症相关。我们对1982年至1992年期间患有不可切除胰腺癌且未接受预防性胃肠造口术而进行胆道减压的患者进行了为期10年的回顾性研究。共研究了50例患者。只有4例患者（8%）发生十二指肠梗阻，需要再次手术进行治疗性胃肠造口术。发生梗阻的平均时间为15.75个月，而总体平均生存期为12.99个月。接受治疗性胃肠造口术患者的平均生存期为32.25个月，第二次手术后平均缓解期为16.5个月。我们得出结论，胰腺癌自然进展迅速，大多数患者生存期不足以发生梗阻。发生梗阻的患者具有特殊性，即他们生存期较长。我们建议常规预防性胃肠造口术并无必要，对于当前或即将发生十二指肠梗阻的情况应选择性地施行胃肠造口术。
