胰腺癌早期诊断及外科治疗探讨
strategies of early diagnosis and surgical treatment for pancreatic carcinoma

武永忠; 阴继凯; 牛瑞霞; 侯东祥; 赖大年; 高德明; 何泽生; 吴金生
第四军医大学唐都医院普通外科; 陕西省人民医院肿瘤科; 西安医学院第二附属医院（陕西辅仁医院）胸外肿瘤科

【中文摘要】目的:探讨胰腺癌早期诊断和提高手术疗效的临床措施。方法:回顾性分析我院自1974年-2001年间连续收治的340例胰腺癌的诊断及外科治疗。结果:本组19.1%(65/340)的胰腺癌病例施行了根治性手术,手术死亡率7.7%(5/65),80.9%(275/340)行姑息性手术及探查术。行根治性手术的胰腺癌病例,首发症状多为上腹部隐痛、胀满不适、纳差、乏力和消瘦等非特异性症状,仅16.9%为无痛性黄疸。影像学检查间接征象检出率分别为胆道扩张97.1%,胆囊肿大88.8%,胰管狭窄、中断、移位和增粗93.8%。对有首发症状的高危人群,联用影像学技术检查直接及间接征象,并及早手术探查,有助于胰腺癌早期诊断。child改良式胰十二指肠切除术后并发症和手术死亡率明显降低。结论:联用影像技术、及早手术探查,早识别,早诊断,早治疗,是提高胰腺癌早期诊断改善疗效的有效措施。根治性手术切除(child改良术式)为主的综合性治疗仍是治疗本病的主要治疗措施。

【英文摘要】 objective:to investigate the strategies of the early diagnosis and surgical treatment of pancreatic carci-noma.methods:diagnosis and surgical treatment"s data of 340 cases with pancreatic carcinoma from 1994 to 2001 were studied retrospectively.results:19.1% cases (65/340) received radical resections,mortality rate was 7.7%.80.9% cases (275/340) received palliative resections and explorations. 83.1% patients who received radical resec-tion had epigastric pain, abdominal distention, anepithymia , debility, emaciation and other atypical complaint asfirst symptoms, only 16.9% had painless jaundice at first. detection of indirect signs for pancreatic carcinoma in im-aging examinations were dilatation of biliary tract(97.1%), gallbladder enlargement(88.8%), and anormaly inpancreatic duct (93.8%) including stricture, discontinuity and translocation. combined with various imaging exami-nations to verify the indirect signs in high-risk population was useful for the early diagnosis of pancreatic carcinoma,surgical treatment should be performed in time.the application of modified child"s operation could decrease the mor-tality and complications.conclusion:it could be contributed to identification, diagnosis and early treatment and im-prove the rate of early diagnosis and the results of the surgical treatment in pancreatic carcinoma to pay more attentionto the high-risk population and adop various imaging examinations in diagnosis, following with surgical exploration.the modified child"s operation for pancreaticoduodenectomy is the first option for pancreatic carcinoma.

【中文关键词】胰腺癌; 早期诊断; 外科治疗

【英文关键词】 pancreatic carcinoma; early diagnosis; surgical treatment