Oláh A, Pardavi G, Mátrai T
Petz Aladár Megyei Kórház Györ, Sebészeti Osztály.
Orv Hetil. 1996 Sep 1;137(35):1915-20.
Authors studied 87 patients with obstructive jaundice secondary to unresectable cancer of the head of the pancreas undergoing palliative biliary bypass procedure. They compared the four different types of biliodigestive anastomoses regarding to the postoperative morbidity, the mortality, the late complications and the survival. Their data suggest that Roux-en-Y choledochojejunostomy with prophylactic GEA is the optimal palliation. They studied the incidence of a second operation for duodenal obstruction. Comparing the operative mortality of each group they suggest that prophylactic gastroenterostomy adds no risk to patients, but they advise it's routine use only with choledochoenteric bypass and in lack of distant metastasis. Survival was significantly higher (p = 0.015) in the group of patients above 70 years. This data support the slower progression of the pancreatic tumor in old-age. They analyse three different factors affecting operative mortality. It was not related to the depth of jaundice and the age of the patients, but it was in a very close correlation with the preoperative blood urea nitrogen level. Authors suppose this parameter a simply and useful criteria in the selection for non-operative palliative procedures.
作者对87例因无法切除的胰头癌继发梗阻性黄疸而接受姑息性胆肠吻合术的患者进行了研究。他们比较了四种不同类型的胆肠吻合术在术后发病率、死亡率、远期并发症和生存率方面的情况。他们的数据表明，预防性胃空肠吻合术的Roux-en-Y胆总管空肠吻合术是最佳的姑息治疗方法。他们研究了十二指肠梗阻二次手术的发生率。通过比较每组的手术死亡率，他们认为预防性胃肠吻合术不会给患者增加风险，但他们建议仅在进行胆肠吻合且无远处转移时常规使用。70岁以上患者组的生存率显著更高（p = 0.015）。这些数据支持胰腺肿瘤在老年时进展较慢的观点。他们分析了影响手术死亡率的三个不同因素。它与黄疸深度和患者年龄无关，但与术前血尿素氮水平密切相关。作者认为该参数是选择非手术姑息治疗方法时一个简单且有用的标准。
