178例胰头癌的诊治分析

Diagnosis and Treatment of 178 patients with carcinoma of the head of pancreas

目的 分析胰头癌的临床表现、诊治方法 ,提高胰头癌的诊治水平。方法 用回顾性方法研究 178例胰头癌的临床表现、诊治方法及治疗效果。结果 178例患者主要临床表现有上腹部疼痛及不适 ,占 6 9.7% ;梗阻性黄疸 ,占 74 .2 % ,这两种症状在Ⅰ、Ⅱ期与Ⅲ、Ⅳ期之间差异均有显著性(P <0 .0 0 1) ;伴腰背部疼痛者占 17.9% ,其中Ⅳ期占 81.3%。对胰头肿瘤检出率B超为 74 .2 % ,CT为 87.3% ,MRI为 85 .5 %。全组行根治性胰十二指肠切除术 18例 (10 .1% ) ,术后 1,3,5年生存率分别为 6 7.5 %、36 .0 %和 5 .6 %。胆汁内引流术 115例。肿瘤未切除而行放、化疗者 ,中位生存期为 7个月。结论 上腹疼痛不适及梗阻性黄疸为胰头癌的常见症状 ,高血糖为多发合并症 ,腰背疼痛常为晚期表现。CT是最重要的影像学诊断方法 ,B超、CT和 (或 )MRI联合检查可提高诊断率 (达 96 .6 % )。目前 ,胰十二指肠切除术是胰头癌唯一有效的治疗方法 。

Objective To improve the diagnosis and treatment of carcinoma of head of pancreas. Methods A retrospective study was carried out to evaluate 178 patients suffering from carcinoma of head of pancreas. Results Pain in the epigastrium and obstructive jaundice were observed in 69.7% and 74.2% of these 178 patients, both of which were of significance ( P <0.001) between stages Ⅰ, Ⅱ and stages Ⅲ, Ⅳ disease. Only 18% of patients had pain in the back, 81.3% of whom belonged to the stage Ⅳ category. The detection rate of the tumor by B ultrasound, CT and MRI were 74.2%, 87.3% and 85.5%, respectively. The success rate of pancreaticoduodenectomy was 10.1%. The postoperative 1 , 3 and 5 year survival rates were 67.5%?36.0% and 5.6%. Internal drainage was performed in 115 patients. The median survival time was 7 months in patients with unresectable tumor who received radiotherapy and/or chemotherapy. Conclusion Pain in the epigastrium and obstructive jaundice are the most common symptoms. Hyperglycemia is the most common complication. Pain in the back implies an advanced lesion. CT is the most important way of diagnosis. Combined use of B ultrasound, CT and MRI may improve the rate of diagnosis up to 96.6%. By now, pancreaticoduodenectomy is still the only effective treatment for the carcinoma of head of pancreas and internal drainage is an important palliative measure.