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目的 探讨胰头癌的早期诊断、并发症防治和姑息性手术术式选择。方法 回顾分析了自 1978年 1月至 1998年 4月2 5 4例胰头癌手术治疗情况。结果 胰头癌首发症状多为无明显诱因的上腹痛、上腹不适、纳差 ( 72 .8% )。 ERCP敏感性最高 ( 92 .9% )。行根治术 67例 ,姑息性手术 187例。在姑息性手术中 :肝 (胆 )总管空肠吻合 +胃空肠吻合术后生存期显著长于胆囊空肠吻合+胃空肠吻合 ( t=2 .67,P<0 .0 2 ) ;胆肠吻合 +胃空肠吻合术后生存期显著长于胆肠吻合 ( t=2 .70 ,P<0 .0 1)。结论 1对高危人群 ,应重视上腹部痛、闷胀不适、纳差等非特异性症状 ,以 B超为首选检查方法 ,B超、CT检查阴性者可采用 ERCP检查。 2八肽生长抑素能在一定程度上预防术后并发症的发生。 3姑息性手术宜采用肝 (胆 )总管空肠 Roux- Y吻合 ,必要时加胃空肠吻合
Objective To explore the early diagnosis of pancreatic cancer, the prevention of complications, and the choice of palliative surgery. Methods Retrospective analysis of surgical treatment of 254 cases of pancreatic cancer from January 1978 to April 1998. Results The first symptoms of pancreatic cancer were upper abdominal pain, upper abdominal discomfort, and anorexia (72.8%) with no obvious cause. The sensitivity of ERCP was highest (92.9%). There were 67 cases of radical surgery and 187 cases of palliative surgery. In palliative surgery: Liver (biliary) jejunostomy + gastrojejunostomy had significantly longer survival than gallbladder jejunojejunostomy + gastrojejunostomy (t = 2.67, P < .02); biliary-enteric anastomosis + stomach The survival time of jejunostomy was significantly longer than that of cholangiojejunostomy (t=2.70, P<0.01). Conclusions 1 For high-risk groups, attention should be paid to non-specific symptoms such as epigastric pain, stuffy discomfort, and anorexia. B-mode ultrasound is the preferred method of examination. B-ultrasonography and CT scans can be used for ERCP examination. Octapeptide somatostatin can prevent postoperative complications to a certain extent. 3 Palliative surgery should use Roux-Y hepatico (biliary) duct jejunum, if necessary, add gastrojejunostomy