胰头癌的诊断和治疗

目的：探讨胰头癌的早期诊断、预后以及各项检测方法的敏感性。方法：回顾性对比分析15年中22例早期胰头癌及168例中晚期胰头癌术前诊断及预后情况。结果：早期胰头癌无特异性首发症状，本组检出率为88．9％，ERCP收集胰液寻找癌细胞诊断胰头癌的敏感性为88．4％，术中针刺细胞学检查敏感性为91．7％。手术切除率90．9％，术后3年生存率为36．4％。均明显高于中晚期胰头癌（分别为36．9％，9．5％）。结论：B超与CT可作为早期胰头癌初步筛选检查方法，ERCP和选择性腹腔动脉造影可提高早期诊断准确性；术前ERCP收集胰液寻找癌细胞和术中细针穿刺细胞学检查可进一步提高早期诊断准确性。早期胰头癌的手术切除和术后治愈率明显高于中晚期胰头癌。

Diagnosis and treatment for carcinoma of the head of pancreas

Objective To study the early diagnosis and the prognosis of carcinoma of the head of pancreas(CHP) and to determine the sensitivity of various detecting methods. Methods Data of preoperative diagnosis and prognosis in 22 patients with early stage of CHP and 168 patients with advanced CHP treated in our department in recent 15 years were retrospectively analyzed and compared. Results The early stage of CHP revealed no specific symptom. In early stage of CHP,the diagnlstic rate was 88.9%, detecting rate of cancer cells in pancreatic juice with ERCP was 88.4%, The sensitivity of needling cytologic examination during operation was 91.7%,the resection rate was 90.9%, 3years survival rate was 36.4%.Those were significantly higher than those in advanced CHP. Conclusions B mode ultrasonography and CT are the first choice of diagnosis for early stage of CHP. ERCP and selective celiac artery angiography can promote diagnostic rate. Searching carcinoma cells in pancreatic juice collected by ERCP and needling cytologic examination during operation can further improve the early diagnostic rate.In patients with early stage of CHP,the resection rate and post operation cure rate are significantly higher than those in patients with advanced CHP.