胰腺癌的围手术期处理

目前胰十二指肠切除术仍是治疗胰腺癌的首选手术方法 ,由于解剖复杂 ,切除脏器较多 ,创伤大 ,手术后并发症亦相对较多 ,其手术死亡率达 15 % ,近年来 ,随着胰腺癌围手术期处理的加强 ,手术死亡率已降至 5 % ,极大提高了手术的安全性。1　胰腺癌的术前处理胰腺癌确诊时只有极少数为早期 ,大多数为进展期 ,患者多消瘦、体质差 ,合并梗阻性黄疸、糖尿病等。若能术前进行针对性处理 ,将会大大提高手术安全性。1.1　术前营养支持　胰腺癌患者术前处于高消耗状态 ,食欲低下甚至引起消化道梗阻 ,摄入减少 ,消耗增加 ,蛋白水平降低 ,免疫能力下降。…     

39例胰腺癌合并糖尿病患者的围手术期护理

胰腺癌合并糖尿病临床常见，部分患者甚至以糖尿病为首发症状。胰腺癌最有效的治疗方法是手术根治，而糖尿病可使患者代谢紊乱、机体修复及抗感染能力下降，增加手术的危险性。2001年8月～2003年6月，我们对39例胰腺癌合并糖尿病患者进行了耐心细致的围手术期护理，效果满意，现将护理体会总结报告如下。     

围术期血液保护在肺癌根治术中的应用体会

自2002年以来,我们对426例行肺癌根治术的患者采用围手术期血液保护措施,取得较好效果。现报告如下。     

直肠癌根治术围手术期的营养护理

1995～2001年，我们对55例直肠癌根治后患者采用三段营养疗法，患者恢复良好。现将护理方法和体会报告如下。     

老年胰腺癌根治术中区域性淋巴结清扫的利弊

胰腺癌是恶性程度高、预后差的消化道肿瘤,其死亡率和发病率之比为0．99：1,近几年来其发病率有明显上升的趋势,其中70％为60～80岁的老年患者。尽管胰腺癌的基础和临床研究已取得了长足的进步,但总体来说,胰腺癌的预后并没有得到显著改善,5年生存率仍低于5％,这主要与其内在的生物侵袭性和发现较晚有关。淋巴转移是胰腺癌重要的转移方式,也是影响胰腺癌手术治疗疗效和预后的重要因素之一,已成为国内外胰腺癌研究的热点。     

老年胰腺癌的诊治进展

胰腺癌的发病率呈持续上升的趋势，随着经济的发展，生活条件改善和人口老龄化时代的到来，与胰腺癌相关的一些危险因素例如慢性胰腺炎、肥胖、糖尿病，甚至缺乏运动均可能加剧上述趋势。然而迄今尚无经济、实用、有效的早期诊断方法，尽管人们在病因学、基因诊断和免疫学方面进行了大量深入的研     

老年胰腺癌的化学治疗

<正>根据2018年GLOBOCAN(https：//www. uicc.org/news/global-cancer-data-globocan-2018)统计,胰腺癌在世界上常见癌症中排名第11位,年新增病例458918例,死亡432 242例(占所有癌症死亡的4.5%)^[1]。     

老年喉癌手术并发症的临床分析

目的 探讨老年喉癌病人手术并发症产生的相关性问题与防治措施.方法 回顾分析1997年10月～2003年10月收治住院的老年(≥60岁)组喉癌病人127例及非老年(＜60岁)组喉癌病人60例的围手术处理资料.结果 老年组和非老年组术后分别有23和6人次发生并发症,均为男性.老年组并发症以感染发生率最高,依次为咽瘘、肺内感染、气管造瘘口感染;其次是应激性胃炎、症状性高血压、并发心力衰竭;发生并发心肺衰竭、下消化道出血者较少;与非老年组比较,差异不显著(χ2=2.288,P＞0.05).术后并发症个体发生情况老龄组有单发也有多发,非老年组以单发为主,二组比较差异(χ2=170,P＞0.01).术后并发症与手术方式的关系,实施半喉切除术后发生并发症老年组与非老年组比较差异显著(χ2=4.10,P＜0.05),实施全喉切除术发生并发症二组差异不显著(χ2=2.928,P＞0.05).而老年组本身实施半喉切除术与全喉切除术发生并发症的差异不显著(χ2=0.89,P＞0.05).术后并发症与全身并存病的关系,无并存病患者术后发生并发症老年组与非老年组比较差异显著(χ2=11.79,P＜0.01);有并存病患者二组差异不显著(χ2=0.039,P＞0.05).而老年组本身无并存病患者与有并存病患者术后发生并发症的差异不显著(χ2=1.77,P＞0.05).结论 老年人机体功能差、并存疾病多,手术后易出现并发症.针对老年人的特点加强围手术特殊问题的防范与处理,能减少并发症,提高治疗效果.     

老年腹部手术病人的围手术期处理

随着年老，老年人各种生理储备功能下降，脏器退行性变并可能合并多种疾病，导致腹部疾病手术治疗的复杂化.因此，老年人周手术期处理十分重要。     

老年直肠癌患者围手术期并发症预防及护理

老年直肠癌发病率逐渐增加,约70%直肠癌发生在65岁以上[1].探讨老年直肠癌围手术期的治疗护理,对于保证手术的安全及疗效、降低死亡率、改善预后具有重要意义.     

Characteristics of pancreatic carcinoma in the elderly

Summary Conclusion Lymphogenous as well as hematogenous metastases were significantly less frequent in the elderly group of patients, although local invasion was comparable. Survival was comparable between both groups although palliative therapy alone was significantly more frequent in the elderly. Background The relative and absolute numbers of elderly patients continue to increase, as does the incidence of pancreatic carcinoma. To determine the optimal therapy for elderly patients with pancreatic carcinoma, we examined their clinicopathological features. Methods The clinical and histopathological features of pancreatic carcinoma in patients 70 yr of age or older (n=89) were compared with those in patients aged 69 yr or less (n=184). Results A total of 273 patients showed histologically tubular adenocarcinomas and their major variants. The male: female ratio peaked at 1∶0.3 in patients under 49 yr old but gradually decreased to 1∶1.2 in those aged over 80 yr. There were no significant differences between the two groups in the resectability, prognosis, location, or histology of the tumor. Hematogenous and lymphogeneous metastases were detected at autopsy in 68 and 61% of patients older than 70, and in 82 and 80% of the younger group.     

The role of extended radical operation for pancreatic cancer

BACKGROUND/AIMS: To clarify the indication of extended operation for pancreatic carcinoma, a clinical study was carried out. METHODOLOGY: From July 1981 to 1999, 196 of 307 (63.8%) patients with pancreatic carcinoma underwent resection of the tumor. Portal vein resection was performed in 145 of these 196 (74.0%) resected cases. The postoperative survival rate was studied according to the operative and histopathological findings. RESULTS: In spite of the aggressive surgery, there was no patient who survived over 3 years after operation in the group carcinoma-positive on the surgical margins. Patients who survived over 3 years postoperatively were observed in the group of carcinoma-free surgical margins. CONCLUSIONS: The most important indication of extended operation combined with portal vein resection for pancreatic cancer is to obtain surgical cancer-free margins. There is no indication of extended operation for cases in which surgical margins will become cancer-positive, if such an operation is employed.     

老年胰腺癌的诊治

胰腺癌是消化系统中相对少见的恶性肿瘤，但近几年来其发病率有明显上升的趋势，其中70％左右为60～80岁的老年病人。从我院统计的资料来看也很相似。我院从2002年6月～2004年4月共收治53例胰腺癌病人，其中60岁以上的老年病人为37例，占69．81％。近年来由于CT、MRI、ERCP、CA19—9等检查的应用，使诊断手段较以往有所进步，     

胰腺癌手术的判断与决策

胰腺癌是公认的癌中之王，临床根治性手术切除仍是目前治疗胰腺癌最有效的方法。胰腺癌切除手术是一种高风险手术，如何进行手术前正确判断、术中正确评估及作出合理术式选择是外科界关注的重点。本文就胰腺癌手术相关问题进行探讨。     

老年进展期胰腺癌98例临床研究

目的探讨进展期胰腺癌不同的治疗方法对预后的影响，以达到治疗的最优化。方法回顾性分析2002年11月至2005年9月收治的98例进展期胰腺癌，分为手术组（81例）：手术[行胆系和（或）肠系转流术、活检术等]加或不加辅助治疗；非手术组（17例）：行非手术治疗；并分析其治疗效果。结果手术组并发症发生率为17．3％（14／81）、病死率为4．9％（4／81），生存期平均为（2．9±2．3）年，加或不加辅助治疗其生存期分别为（2．9±3．7）年、（2．8±3．1）年；非手术组无并发症和死亡，生存期平均（2．7±2．1）年。结论对进展期无法行根治性切除术的胰腺癌、姑息性切除是无益的，对伴发胆系和（或）肠系梗阻时行转流术是必须的，围手术期辅助治疗是改善预后的重要方法。     

Clinicopathological study of autopsy cases of pancreatic carcinoma in the elderly]

A total of 257 autopsy cases of pancreatic carcinoma, including 160 male and 97 female cases with an average age of 68.2 years, were divided into an aged group (70 years or older, 136 cases) and a control group (younger than 70 years, 121 cases), and their respective clinicopathological features were compared. The male to female ratio was 1.2:1 in the aged group and 2.6:1 in the control group. In both groups, abdominal pain was noted in about one-third of the cases as the primary symptom, followed by appetite loss and icterus. Concerning the primary symptoms, the two groups did not differ from each other. The rate of surgical resection was higher in the control group (24.0%) than the aged group (10.3%). Mean survival times were similar in both groups (5.71 months for the aged group and 6.01 for the control group). Intrapancreatic location of the tumor showed similar tendencies in both groups. However, cancer of the head of the pancreas was 2.3 times more common than body/tail cancer in cases aged 80 or more. Approximately 90% of the cases were diagnosed as ductal carcinoma by histological examination. The degree of differentiation was similar in both groups, but the well differentiated type was somewhat predominant in cases 80 years or older. Metastasis or direct invasion was noted to the liver, peritoneum and lung in this order in both groups. Liver and lymph node metastasis were less frequent in cases 80 years or older. Multiple primary cancers were noted in 8.8% of the aged group and 9.1% of the control.(ABSTRACT TRUNCATED AT 250 WORDS)     

Extended radical operation of pancreatic head cancer： Appraisal of its clinical significance

AIM: To evaluate the significance of extended radical operation and its indications. METHODS: Between January 1995 and December 1998, 56 inpatients with pancreatic head cancer received operation. Among them 35 patients (group 1) experienced the Whipple operation, and 21 patients (group 2) received the extended radical operation. The 1-, 2-, 3-year cumulative survival rates were used to evaluate the efficacy of the two operative procedures. Clinical stage (CS) was assessed retrospectively with the help of CT. The indications for extended radical operation were discussed. RESULTS: There was no difference in hospital mortality and morbidity rates. Whereas the 1-, 2-, 3-year cumulative survival rates were 84.8%, 62.8%, 39.9% in the extended radical operation group, and were 70.8%, 47.6%, 17.2% in the Whipple operation group, there was a significant difference between the two groups (P<0.001, P<0.001, P<0.001, respectively). Most of the deaths within 3 years after operation were due to recurrence in the two groups. However, the 1-, 2-, 3-year cumulative rates of death due to local recurrence were decreased from 37.4% in patients that received the Whipple procedure to 23.8% in those who received by extended radical operation. Patients who survived for more than 3 years were only noted in those with CS1 in the Whipple procedure group and were founded in cases with CS1, CS2 and part of CS3 in the extended radical operation group. CONCLUSION: The extended radical operation appears to benefit patients with pancreatic head carcinoma which was indicated in CS1, CS2 and part of CS3 without severe invasion.