姑息性手术治疗不能切除的胰头癌

PALLIATIVE SURGERY FOR UNRESECTABLE CARCINOMA OF THE HEAD OF PANCREAS

本文报告我院１０年间姑息性手术治疗不能切除的胰头癌１００例。最常见的症状为黄疸（８１％），腹痛或背痛（５２％），体重减轻（４３％）。手术方法：肝总管空肠Ｒｏｕｘ－Ｙ形吻合术４７例，肝总管空肠Ｒｏｕｘ－Ｙ形吻合和胃空肠吻合术３７例，胆囊空肠Ｒｏｕｘ－Ｙ形吻合术８例，肝内或肝外胆管置管外引流术８例。手术死亡率为６％，胆肠吻合和预防性胃空肠吻合术的手术死亡率为５．４％。近期并发症为３９％，其中伤口感染多见。远期并发症为２３％，其中以胆囊空肠吻合术后的胆管炎和黄疸多见。我们认为姑息性手术治疗不能切除的胰头癌应尽量选择肝总管空肠Ｒｏｕｘ－Ｙ形吻合术，同时作预防性胃空肠吻合。

rom January 1983 to January 1992, palliative surgery of 100 cases of unre-sectable carcinoma of the head of pancreas were performed in the authorsi hospi-tal. In which, 47 patients underwent hepatic duct-jejunostomy, 37 patients un-derwent the forenamed anastomosis plus prophylactic gastrojejunostomy, 8 pa-tients underwent cholecystojejunostomy,and 8 patients underwent extrahe-paticor intrahepatic external biliary drainage. The operation mortality rate was 6% asa whole. Retrograde cholangitis occurred in 2 (25%) of the cholecystoje-junostomy cases, but occurred only in 5 (5. 9%) of the hepatic duct-jejunostomypatients .Recurrent jaundice occured in 3 (37. 5%) of the cholecystojejunostomy cas-es, but only in 7 (8. 3%) of the hepatic duct-jejunostomy cases. 6 cases withouta gastro-jejunostomy eventially occured duodenal obstruction. Prophylactic gas-tro-jejunostomy didntt increase the operation mortality rate (5. 4% vers 6%).The authors conclude that in palliative surgery for unresectable carcinoma of thehead of pancreas, hepatico duct-jejunostomy and prophylactic gastrojejunostomyis the treatment of choice.