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胰腺癌是一种预后很差的恶性肿瘤 ,85 %的病人在确诊后 12个月内死亡 ,5年生存率仅为 1%～ 2 %。胰腺癌预后差的原因主要包括 :(1)很难在疾病早期做出诊断 ;(2 )当发现胰腺发生病变时 ,又很难对疾病进行正确分期 ;(3)外科手术治疗的并发症和死亡率仍然较高 ;(4)缺乏有效的肿瘤辅助治疗手段。胰腺癌的分期非常重要 ,它可以尽早地区分肿瘤可切除的病人与不可切除的病人 ,避免不必要的剖腹探查术。在过去的 2 0年中 ,用于胰腺癌分期的影像学技术越来越多 ,取得了很大进步 ,它们包括 :超声探测 ,双相螺旋CT扫描 ,选择性脏器血管造影 ,内窥镜逆行胰胆管造影 ,超速核磁共振 ,以及腹腔镜检查。它们各有优缺点 ,需综合分析几项检查结果才能得出准确分期。随着诊断和外科手术技术的提高 ,尤其是在拥有胰腺专业外科医师的疾病治疗中心 ,胰十二指肠切除术的并发症和死亡率近 2 0年有了明显下降 ,同时手术切除率和术后生存率也有稳步提高。Whipple手术虽然仍是壶腹周围癌的标准手术方式 ,但是越来越多的外科医师将保留幽门的胰十二指肠切除术用于胰头癌的治疗 ,并证明它是一种安全、根治性切除手术。保留幽门的胰十二指肠切除术术后生存率、局部复发和远处转移与Whipple手术一样 ,但是术后病人的生活质量、体重增加?
Pancreatic cancer is a poor prognosis of malignant tumors, 85% of patients died within 12 months after diagnosis, 5-year survival rate was only 1% to 2%. The causes of poor prognosis of pancreatic cancer include: (1) it is difficult to make a diagnosis early in the disease; (2) it is very difficult to correctly stage the disease when pancreatic lesions are found; (3) the complications of surgical treatment and The mortality rate is still high; (4) the lack of effective adjuvant treatment of cancer. The stage of pancreatic cancer is very important, it can be as early as possible to distinguish between resectable tumor patients and unresectable patients, to avoid unnecessary laparotomy. In the past 20 years, more and more imaging techniques have been developed for the staging of pancreatic cancer. These include: ultrasound, biphasic spiral CT, selective organ angiography, endoscopy Retrograde cholangiopancreatography, speeding nuclear magnetic resonance, and laparoscopy. They have their own advantages and disadvantages, need a comprehensive analysis of several test results to arrive at an accurate staging. With the improvement of diagnosis and surgical techniques, especially in the disease treatment center with pancreas professional surgeons, complications and mortality of pancreaticoduodenectomy have been significantly reduced in the past 20 years. At the same time, the surgical resection rate and Postoperative survival has also steadily improved. Although Whipple surgery is still the standard surgical method for periampullary carcinoma, more and more surgeons will keep pyloric pancreaticoduodenectomy for the treatment of pancreatic head cancer and prove it to be a safe, radical Sexual resection surgery. Postoperative survival rate of pylorus-preserving pancreatoduodenectomy, local recurrence and distant metastasis were the same as Whipple’s, but postoperative patients’ quality of life and weight gain increased.