胰腺癌的早期诊断及外科治疗

目的总结胰腺癌临床诊治中的问题，对胰腺癌的早期诊断及治疗进行探讨，以期进一步改善胰腺癌患者的预后。方法回顾性分析308例胰腺癌患者的临床资料，包括首发症状、临床诊断、治疗及预后。结果308例患者中，首发症状中非特异性消化道症状占74．4％，黄疸占23．7％。术前影像学检查阳性率分别为CT88．9％，MRCP85．7％，B超84．4％，ERCP82．1％。根治性切除率18．8％，其中胰头癌行胰十二指肠切除术16．8％，胰体尾癌行联合脏器切除24．4％。术后发生胰瘘4例(1．5％)，经药物治疗后痊愈。手术死亡4例(1．5％)，其余患者恢复良好。结论临床上胰腺癌的早期诊断率低，对高危可疑患者应联合应用影像学，肿瘤标志物，穿刺．剖腹探查等方法才能提高诊断率。明确诊断后应积极进行手术治疗，降低术后并发症和病死率，延长患者生存期。

EARLY DIAGNOSIS AND SURGERICAL TREATMENT FOR PANCREATIC NEOPLASM

Objective To summarize the clinical experience for early diagnosis and management of pancreatic neoplasm.Methods 308 cases with pancreatic neoplasm were studied retrospectively.The data included clinical manifestations,diagnosis,treatments and prognosis.Result The most common symptoms were some non-particular alimentary symptoms,which were about 74.4%.Jaundice was about 23.7%.The positive rate of image examination was 88.9% by CT,85.7% by MRCP,84.4% by B-ultrasound and 82.1% by ERCP.The radical respectability rates were 18.8%.Of them,pancreatoduodenectomy was performed for 16.8% of patients with cancer in the heads,while combined organs resection was performed in 24.4% of patients with cancer in the pancreatic body and tail.Pancreatic fistula occurred in 4 cases(1.5%),and 4 patients died.Conclusion Early diagnosis for pancreatic neoplasm is difficult for clinical doctors.All suspected patients with high risks should undergo medical examination,which combined image examination,tumor markers,puncture and operation.Comprehensive surgical treatment is the main management for patient with pancreatic neoplasm.