不能切除的胰腺癌经腹腔镜旁路手术42例报告

Treatment of unresectable late carcinoma of the pancreas by gastric bypass and laparoscopic cholecystoje-junostomy:Report of 42 cases

目的探讨对晚期胰腺癌所致的十二指肠梗阻和胆道梗阻同步行腹腔镜胃肠联合胆肠内引流术的可行性和临床疗效。方法回顾性分析我们于2002年1月-2006年6月对42例晚期胰腺癌病人行腹腔镜胃空肠吻合术联合胆囊空肠吻合术的临床资料。结果本组42例手术均获成功。手术时间为66～189min，平均（92±21）min；术中出血33-411ml，平均（65±23）ml；术后3～5d病人胃肠功能恢复；住院时间10-24d，平均（12．3±3．5）d。术后有2例发生切口感染，无其它手术并发症。术后病人恢复经口进食，黄疸逐渐消退。结论腹腔镜胃空肠、胆肠吻合姑息治疗晚期胰腺癌具有创伤小、长久保持经口进食，减黄彻底，病人术后痛苦轻、住院时间短等特点。

Objective To assess the feasibility and clinical effectiveness of gastric bypass and laparoscopic cholecystojejunostomy in the treatment of unresectable carcinoma of the pancreas. Methods Between January 2002 and June 2006, laparoscopic cholecystojejunostomy and gastric bypass were performed successfully on 42 consecutive patients with unresectable carcinoma of the pancreas. Endoscopic noso-biliary drainage（ENBD）was performed before the operations. Results All procedures were completed laparoscopically. Jaundice and hepatic function of the patients were improved obviously after the bypass. Oral nutrition was recovered after operations. The mean operative time was（92±21 ）min （range.66-189min）. The mean operative blood loss was（65± 23）ml（range： 33-441ml）. The time for bowel function recovery and liquid intake was started on the 3^rd-Sth post-aperatively days. Average hospital stay was（ 12. 3 ± 3. 5）days（range： 10-24 days）. Incision was infected in 2 patients, and no complications occurred in the remaining patients. Conclusion Treatment of unresectable late carcinoma of the pancreas by laparoscopic cholecystojejunostomy and gastric bypass associated with ENBD is a minimally invasive technique with less postoperative pain, shorter hospital stay, less procedure-related morbidity.