摘要
目的：探讨胰头癌早期诊断和降低十二指肠切除术后胰瘘发生率及手术死亡率的措施。方法：回顾性分析我院1990年5月至2004年5月收治的299例胰头癌的临床资料，对其首发症状和根治性切除后并发症发生率分析。结果：（1）胰头癌的早期症状为上腹部胀痛，闷胀不适，食欲下降伴明显乏力和体重减轻，影像技术联合应用可发现胰头癌的间接征象（胆总管扩张，或末端呈“毛笔”尖样，胰管增粗、移位等）。（2）胰腺残端闭锁胰肠套入式吻合加空肠盲端减压术后并发症和手术死亡率明显降低。结论：（1）对高危病人提高警觉，联合应用影像技术可提胰头癌的早期诊断。（2）PD改良式Childs重建是减少术后胰瘘和手术死亡的有效措施。
Objective ：To study the measures for early diagnosis of carcinoma of pancreas head and reduction the incidence of postoperative pancreatic fistula and mortality rate. Methods ：The clinical data of 299 eases of carcinoma of pancreas head admitted to our hospital from May 1990 to May 2004 were retrospectively reviewed and the initial symptoms and incidence of complication were analysed. Results：（1）The early symptoms of carcinoma of pancreas head were epigastralgia, discomfort and distention of upper abdomen,anorexia combined with obvious hypodynamia and weight loss,using imaging technology,indirect signs（eholedoeheetasia,distal end as ＂tip of writing brush＂, widening and displacement of pancreatic duct eet） may be found. （2）The complications and operative mortality were markedly decreased after panereatieojejunostomy with closed pancreas stump and invagination of pancreas into jejunum in combination of decompression of jejunum end. Conclution：（1）Improving watchfulness to high risk patients combined with imaging technology can raise the early diagnosis of carcinoma of pancreas head.（2）Modified PD of ehilds reconstruction is an effective measure to decrease the postoperative pancreatic fistula and operative mortality.
