摘要
本文由四部分组成。（１）胰腺癌诊断治疗现状：胰腺癌早期诊断困难，临床患者四分之三为Ⅲ、Ⅳ期患者，很少有Ⅰ期患者。手术切除率约在２０％左右，切除后５年生存率约在１０％左右。我院４３７例中手术切除率为９．１％，切除后５年生存率为７．０％（３／４３）。（２）延误诊断和治疗的原因：我院２９２例胰腺癌中，来院前误诊率为４０．４％，在我院术前误诊率仍达１２．６％。误诊原因包括与慢性胰腺炎及良性梗阻性黄疸鉴别困难，以及肿瘤的部位等。（３）如何发现早期胰腺癌或小胰癌：首先应提高警惕，在高危人群中查找，即在４０岁以上有胰腺癌诸多症状并有胰腺炎或糖尿病病史者中查找。在排除肝胆、胃肠和腹腔肿瘤等疾病后，要高度怀疑胰腺癌。（４）如何提高治疗效果：全胰切除降低生存质量，故目前多主张有条件者应行适当的扩大切除术。即在腹主动脉左缘切断胰腺，在肝总管水平切断胆管，紧靠肠系膜上动脉左缘切除钩突，并行胰周淋巴结廓清的整块切除。只行一般的胰十二指肠或胰体尾切除是不够的。
Abstract The four aspects are discussed in this paper. (1) The present conditions of the management of pancreatic cancer. It is difficult to make early diagnosis of pancreatic cancer,the three fourth of clinical cases is in the advanced stage ( Ⅲ or Ⅳ stage). Surgical resection rate is about 20% ,5-years survival rate is about 10% in resectable patients. In the authors'hospital, surgical resection rate is 9. 1% in 473 cases,5-years survival rate is 7% (3/ 43) in resectable patients. (2) The causes of delayed diagnosis and treatment. The misdiagnosis rate is 40. 4% before patients were admitted, preoperative misdiagnosis is still 12. 6% in our 292 cases with pancreatic cancer. The causes of misdiagnosis include difficulty in differential diagnosis with chronic pancratitis and benign obstructive jaundice,the location of tumor (tumor is located in uncinate process of pancreas). 5 misdiagnosed cases are discussed in this section. (3) How to find early cases. The high risk group is the group more than the age of 40 complained of nonspecial gastrointestnal symptoms with the history of pancreatitis or diabetes. After the common gastrointestinal disorders are ruled out, pancreatic cancer should be suspected. (4) How to improve prognosis. Total pancreatectomy decrease the life of quality. It is suggested to perform proper extensive pancreatoduodenectomy, which includs division of pancreas at the left margin of abdominal aorta, division of bile duct at the level of common hepatic duct, division of uncinate process of pancreas closed to the left margin of superior mesenteric artery ,and removal of parapancreatic lymph nodes (en-block resection ). The classical pancreatoduodenectomy is not enough for radical resection of tumor.
出处
《普外临床》
CSCD
1994年第6期321-325,共5页
