无法切除的胰腺癌的冷冻手术治疗(附44例报告)

目的探讨冷冻手术对无法切除的胰腺癌的治疗效果。方法对近7年44例无法切除的胰腺癌进行冷冻治疗。胰腺癌冷冻手术附加内引流术(胆囊或胆管空肠吻合 胃空肠吻合术)共28例，同时联合区域性灌注化疗20例，联合腹腔神经丛无水乙醇区域性注射镇痛20例。大多数病人(77．4％，34／44)常规行空肠造瘘术，用作术后肠内营养通道。术后常规观察，定期检查血CA19-9、CT、血淀粉酶等。结果全组无手术死亡。术后腹、背疼痛缓解率89、47％(34／38)，多数肿瘤有不同程度缩小，血CA19-9下降，血淀粉酶1周内轻度升高，但无胰腺炎表现。主要并发症为胃排空障碍(40．90％，18／44)。34例获得随访，中位生存期14个月，1年生存率为57．5％。许多存活者还在继续随访中。结论冷冻手术对无法切除的胰腺癌病人是安全、简便、有效、可供选择的一种新的治疗手段。

Cryosurgery for unresectable pancreatic carcinoma:a report of 44 cases

Objective To study the effect of cryosurgery on unresectable pancreatic carcinoma. Methods Cryosurgery was performed for 44 patients with pancreatic carcinoma in the past 7 years. Of the patients, 28 simultaneously received cholecystojejunostomy or cholangiojejunostomy and gastrojejunostomy, 20 regional chemotherapy and 20 chemical splanchniectomy by injection of ethanol except for cryosurgery. Jejunostomy for intra-intestinal nutrition was conducted in 77.4% (34/44). CT scanning and determination of serum CA 19-9, amylase were regularly conducted after the operation. Results There were no intraoperative death and postoperative pancreatitis. Abdominal and dorsal pain was controlled in 89.47% of the patients. Pancreatic carcinoma shrank in CT film and serum level of CA 19-9, amylase decreased in most of the patients. Serum amylase level slightly increased in some patients within 1 week after the operation. The major postoperative complication was gastroparesia and it developed in 40.9% of the patients. Thirty-four patients were followed up. The median survival time was 14 months and the 1-year survival rate was 57.5%. Conclusions Cryosurgery is a safe, convenient, effective and new means for treatment of the unresectable pancreatic carcinoma.