两种姑息性旁路手术方式治疗进展期胰头癌疗效比较

目的比较两种姑息性旁路手术治疗无法切除的进展期胰头癌的疗效。方法无法手术切除的进展期胰头癌37例,行单纯胆管空肠吻合术29例(单旁路手术组),胆管空肠吻合联合预防性胃空肠吻合术8例(双旁路手术组)。结果单旁路术和双旁路术后并发症发生率分别为37.9%和50.0%(P>0.05),两组均无住院死亡,1年生存率分别为41.4%、37.5%,两年生存率为3.4%、12.5%,生存时间分别为(10.7±6.7)月、(11.6±10.8)月,差异均无统计学意义(P>0.05)。但术后单旁路术组发生胃输出口梗阻11例(37.9%),明显高于双旁路术组(0),P<0.05。结论行预防性胃空肠吻合术的双旁路手术治疗无法切除的进展期胰头癌优于单纯的胆管空肠吻合术,尽管术后远期生存并无差别,但可以明显降低发生胃输出口梗阻的风险,同时并不增加并发症及死亡率。     

不合并消化道梗阻的晚期胰头癌441例临床诊治分析

目的 分析不合并消化道梗阻的晚期胰头癌的临床资料,探讨治疗策略.方法 回顾性分析2001年1月至2010年12月收治的441例不伴消化道梗阻的晚期胰头癌患者的临床资料.结果 所有患者均行手术治疗,其中行胆囊-空肠Roux-en-Y吻合术(A组)101例,胆总管-空肠Rouxen-Y吻合术(B组)133例,胆囊-空肠Roux-en-Y吻合+胃-空肠吻合术(C组)83例,胆总管-空肠Roux-en-Y吻合+胃-空肠吻合术(D组)124例.术后A、C两组分别有7.9％及6.0％的患者再发胆道梗阻,A、B两组分别有8.9％及8.3％的患者出现消化道梗阻,四组患者生存时间差异无统计学意义(F=1.933,P=0.123).结论 对不合并消化道梗阻的晚期胰头癌患者,胆总管空肠吻合术能有效预防术后再次胆道梗阻;预防性胃空肠吻合术能显著降低患者术后消化道梗阻发生率,而胆囊-空肠吻合术仅可在患者一般情况较差或胆管吻合条件不具备时谨慎选用.     

胃上部癌两种不同手术方式比较分析

目的：探讨进展期近端胃癌不同手术方式对患者生活质量和预后的影响。 方法：回顾性分析4年间收治的110例胃上部癌患者临床资料,其中53例行近端胃根治性切除,保留远端胃,行食管-空肠端侧吻合、残胃-空肠侧侧吻合、空肠-空肠端侧吻合的双通道消化道重建（双通道吻合组）;57例行常规全胃切除,食管-空肠Roux-en-Y吻合（Roux-en-Y吻合组）。 结果：双通道吻合组与Roux-en-Y吻合组1,3,5年生存率分别为99.4%和98.7%,67.3%和65.7%,15.7%和17.2%,组间差异无统计学意义（P>0.05）;双通道吻合组患者在预防倾倒综合征及反流性食管炎方面明显优于Roux-en-Y吻合组（均P<0.05）,两组间在术后梗阻、出血、感染等并发症方面无统计学差异（均P>0.05）;患者术后1年的体质量、血浆总蛋白、血浆白蛋白、血红蛋白等方面的变化双通道吻合组均明显优于Roux-en-Y吻合组（均P<0.05）。 结论：保留远端胃,行残胃与空肠双通道吻合治疗胃上部癌符合手术规范,不影响根治原则,提高了患者术后的生活质量,是胃上部癌根治术较理想的消化道重建方式。     

胰头癌胆肠梗阻的简易腹腔镜内引流术治疗初探

目的 探讨治疗胰头癌胆管和/或十二指肠梗阻较简易的腹腔镜手术方法。方法 施行腹腔镜探查术(LE)、腹腔镜胆总管支架术(LCBDS)、腹腔镜联合术后胆道镜连续支架术(LCCDS)、腹腔镜肝总管—十二指肠架桥内引流术(LCHDB)、腹腔镜胃空肠吻合及胆囊空肠架桥内引流术(LGCJB)、腹腔镜胃空肠吻合及肝总管空肠架桥内引流术(LGHJB)，治疗胰头癌胆管和，或十二指肠梗阻。结果 19例CT增强扫描怀疑胰头癌，临床怀疑转移而行内引流术。LE怀疑转移病灶取标本中9例病理报告胰腺癌，10例未证实。19例中15例手术获成功(无胆漏、内引流通畅、黄疸减轻或消退)，1例中转开腹放置塑料支架，1例少量胆漏腹腔引流自愈，1例LCBDS术后15d死于肝肾肺功能衰竭，1例LCBDS术后15d死于肝肾功能衰竭。结论 选择合适病例，采用较简易的腹腔镜内引流术治疗胰头癌胆管和/或十二指肠梗阻有效、可行。     

胰头癌胆肠梗阻的简易腹腔镜内引流术治疗初探

目的 探讨治疗胰头癌胆管和/或十二指肠梗阻较简易的腹腔镜手术方法。方法 施行腹腔镜探查术(LE)、腹腔镜胆总管支架术(LCBDS)、腹腔镜联合术后胆道镜连续支架术(LCCDS)、腹腔镜肝总管-十二指肠架桥内引流术(LCHDB)、腹腔镜胃空肠吻合及胆囊空肠架桥内引流术(LGCJB)、腹腔镜胃空肠吻合及肝总管空肠架桥内引流术(LGHJB),治疗胰头癌胆管和/或十二指肠梗阻。结果 19例CT增强扫描怀疑胰头癌,临床怀疑转移而行内引流术。LE怀疑转移病灶取标本中9例病理报告胰腺癌,10例未证实。19例中15例手术获成功(无胆漏、内引流通畅、黄疸减轻或消退),1例中转开腹放置塑料支架,1例少量胆漏腹腔引流自愈,1例LCBDS术后15d死于肝肾肺功能衰竭,1例LCBDS术后15d死于肝肾功能衰竭。结论 选择合适病例,采用较简易的腹腔镜内引流术治疗胰头癌胆管和/或十二指肠梗阻有效、可行。     

不同胃癌根治性切除术及重建术式临床效果分析

目的：探讨不同近端胃癌根治性切除术及重建术式的临床效果与术后生存情况。方法：分析2006年1月—2011年10月82例行近端胃癌根治切除术患者资料,其中22例行近端胃切除术后食管残胃吻合重建（食管胃吻合组）,40例行全胃切除术后Roux-en-Y食管空肠吻合重建（食管空肠Roux-en-Y吻合组）,20例行近端胃切除术后功能性空肠间置重建（空肠间置组）,比较三组患者手术指标、术后并发症、营养状态以及术后生存率。结果：食管胃吻合组手术时间、出血量均明显少于另两组（均P<0.05）;食管空肠Roux-en-Y吻合组淋巴结清扫数明显多于另两组,但营养指标方面不如另两组（均P<0.05）;三组并发症总发生率均无统计学差异（P>0.05）,但食管空肠Roux-en-Y吻合组腹泻、倾倒综合征发生率明显高于另两组（均P<0.05）;三组患者1、3年生存率差异均无统计学意义（χ2=0.891,P=0.554;χ2=0.419,P=0.831）。结论：三种近端胃癌手术生存率相似,近端胃切除术加食管残胃吻合创伤性小,近端胃切除术加功能性空肠间置术后生活质量更高,临床应根据患者实际情况选择方案。

     

处理肝门部原发胆管癌的手术探讨:决断难题

限于主肝管结合部及其以上近端恶性胆管梗阻的50例病人进行了手术治疗。A组30例做完全或部分肿瘤切除,B组20例完全切除肿瘤并进行了附加处理。附加处理包括单纯肝切除(11/20),局部血管结构的切除及重建(9/20)。所有病人都做了肝内胆管树的重建,即在主段肝管与Roux-en-Y空肠袢之间做肝内胆管空肠吻合术。在每一主段肝管开口处,引流两到三个段肝管。仅临时使用了经吻合口引流管。 8例死亡,A组(3/30)3例,B组(5/20)5例,     

经腹全胃切除治疗胃癌170例临床分析

目的 探讨胃癌患者行全胃切除的适应证，合理手术入路的选择及术后消化道的重建方式，方法 复习经腹全胃切除术的170例胃癌患者的临床资料。结果 根治性全胃切除132例，姑息性全胃切除38例，联合脏器切除18例，全胃切除后采用食管空肠Roux-Y吻合重建消化道110例，间置空肠法重建消化道60例，食管空肠Roux-Y吻合发生倾倒综合征20例，返流性食管炎6例，间置空肠法重建消化道无一例发生，结论（1）胃癌尤其是胃底贲门癌采用经腹手术效果较好。（2）严格掌握手术适应证，采用全胃切除可提高胃癌患者的生存期及生存质量。（3）根治性全胃切除术后采用间置空肠重建消化道优于食管空肠Roux-Y法。     

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对于不可切除胰头肿瘤的姑息性治疗,如果预期生存时间短,明确有远处转移或年老体弱全身状况差手术有禁忌者,可采用经十二指肠镜向梗阻近侧胆管内置入内支架或经皮经肝的胆道穿刺置管引流(PTBD)等微创治疗。否则应行剖腹探查,确认无法切除者,可行胆管空肠加胃空肠Roux-en-Y吻合,如果胰高压明显,还需加行胰管空肠吻合,消化道重建顺序是胰肠、胆肠和胃肠。     

胃空肠吻合和自膨式金属支架置入治疗恶性胃出口梗阻的meta分析

目的通过meta分析的方法评价胃空肠吻合和自膨式金属支架置入(简称"金属支架")治疗胃出口梗阻的疗效和安全性。方法全面检索了PubMed、Embase、Cochrane Library、Web of Science、Clinical Trial、维普、中国知网、万方数据等数据库,纳入了评价胃空肠吻合和金属支架治疗胃出口梗阻研究的文献,提取资料并评价后用RevMan 5.3软件进行meta分析。结果最终纳入12篇文献共1 505例患者,其中胃空肠吻合组620例,金属支架组885例;3篇随机对照试验(RCT),9篇非RCT。meta分析结果显示,金属支架组的住院时间和术后恢复饮食时间明显短于胃空肠吻合组[MD=5.83,95%CI(4.24,7.42),P0.000 01;MD=3.41,95%CI(1.79,5.03),P0.000 1];虽然胃空肠吻合组的并发症率明显高于金属支架组[OR=1.85,95%CI(1.27,2.70),P=0.001],但是胃空肠吻合组的技术成功率和临床成功率明显高于金属支架组[OR=2.72,95%CI(1.13,6.53),P=0.03;OR=1.86,95%CI(1.35,2.57),P=0.000 2],且其生存时间也明显长于金属支架组[MD=38.31,95%CI(28.98,47.64),P0.000 01]。2组非RCT研究亚组分析均与总体结果一致,而RCT研究亚组分析仅住院时间和术后恢复饮食时间与总体结果一致。结论支架置入在恢复饮食能力、住院时间、并发症率等疗效方面更具优势,而胃空肠吻合术在生存时间、技术成功率和临床成功率方面的疗效更好。在临床实践的过程中,可根据患者的具体情况选择不同的术式。     

腹腔镜胆肠吻合术治疗恶性梗阻性黄疸

目的 :探讨腹腔镜胆囊空肠吻合术治疗恶性梗阻性黄疸的效果。方法 :5例晚期胰腺癌经腹腔镜和腹腔镜超声探查分期后行腹腔镜胆囊空肠吻合及胃空肠吻合术 ,3例采用吻合器、2例行手工缝合完成手术。结果 :5例腹腔镜手术均顺利完成 ,平均手术时间 1 2 0min ,平均住院 7d ,无腹腔镜手术并发症 ,平均随访 8个月生存良好。结论 :腹腔镜胆肠吻合术治疗恶性梗阻性黄疸疗效可靠 ,可作为微创姑息治疗的新途径。     

原发性十二指肠癌的诊断与外科治疗

目的　探讨原发性十二指肠癌 (PDC)的诊断与外科治疗。　方法　回顾分析 1983～1997年间外科手术治疗的PDC 2 2例。腹痛及上腹部不适 11例、黄疸 5例、恶性呕吐 4例、上腹部胀满感 2例 ,内镜、十二指肠低张造影、B超及CT扫描诊断正确率分别为 90 0 % ( 9/ 10 )、86 7% ( 13/ 15 )、33 3% ( 4/ 12 )及 5 8 3% % ( 7/ 12 )。本组 2 2例患者均行开腹手术 ,包括行胰头十二指肠切除术 (PD) 12例、节段性肠管切除术 (SR) 4例及短路手术 6例。　结果　PDC无特异临床表现 ,诊断主要依靠内镜及十二指肠低张造影。本组随访率为 86 4% ( 19/ 2 2例 ) ,无肿瘤残留的根治性切除病例 (包括PD 12例及SR 4例 ,1例PD患者失访 )的 1、3、5年生存率分别为 86 7% ( 13/ 15 )、46 7% ( 7/ 15 )及 2 6 7% ( 4/15 )。PD组 5年生存率为 2 7 3% ( 3/ 11)、SR组 4例患者 5年后存活 1例 ,而短路手术者 ( 2例失访 )无一例生存超过 1年 ,2者之间的差异有非常显著性意义 ( χ2 =6 84,P <0 0 1)。　结论　根治性外科切除治疗可提高原发性十二指肠癌的长期生存率。     

Randomised clinical trial of two bypass operations for unresectable cancer of the pancreatic head.

OBJECTIVE: To compare two different types of prophylactic gastric bypass in patients with cancer of the pancreatic head who were not suitable for curative resection. DESIGN: Prospective study. SETTING: University hospital, Turkey. SUBJECTS: 44 patients with unresectable cancer of the pancreatic head without duodenal obstruction who presented between May 1995 and June 2000 who were randomised into 2 groups. INTERVENTIONS: 22 patients had an antecolic, isoperistaltic gastrojejunostomy, jejunojejunostomy, and hepaticojejunostomy after cholecystectomy. The remaining 22 had a hepaticojejunostomy and antecolic, antiperistaltic gastrojejunostomy procedure after cholecystectomy. MAIN OUTCOME MEASURES: Mortality, morbidity, postoperative course, and survival. RESULTS: There were no significant differences between the groups in the incidence of postoperative complications, time until restoration of oral diet, relaparotomy rate, late upper gastrointestinal bleeding, mortality, duration of hospital stay, and survival. The isoperistaltic operation took significantly longer than the antiperistaltic operation (p < 0.001) and there was less delayed gastric emptying in the antiperistaltic group but not significantly so. Both operations caused a significant lengthening in the postoperative gastric emptying time (p = 0.04 and p = 0.01, respectively). CONCLUSION: Both procedures are suitable for patients with unresectable carcinoma of the pancreatic head without impending duodenal obstruction. There was a trend towards better clinical results with the isoperistaltic procedure.     

Postoperative morbidity and long-term survival after pancreaticoduodenectomy with superior mesenterico-portal vein resection

The role of superior mesenteric-portal vein resection (SM-PVR) for vein invasion or tumor adherence during pancreatoduodenectomy (PD) is still under debate. We investigated morbidity, mortality, and long-term survival in patients who underwent PD with or without SM-PVR. Between July 1994 and December 2004, 222 PD (78% pylorus preserving, 19% Whipple, and 3% total pancreatectomy) were performed for malignant disease. Fifty-three patients (24%) had PD with SM-PVR. Sixty-eight percent of the venous resections were performed as wedge excisions and 32% as segmental resections. Long-term survival was analyzed in 165 patients with pancreatic (n=110), ampullary (n=33), or distal bile (n=22) duct cancer using univariate (log-rank) and multivariate (Cox regression) methods. In patients undergoing PD with SM-PVR and conclusive histologic examination of the resected vein specimen (n=42), 60% had true tumor involvement of the venous wall, whereas 40% had no proven tumor infiltration. In the complete study group, negative resection margins were obtained in 69% of patients with SM-PVR and in 79% of patients without SM-PVR (P=0.09). Median duration of surgery was 500 minutes (SM-PVR) versus 440 minutes (no SM-PVR; P<0.001). Volume of intraoperatively transfused blood was 600 ml (median) in both groups. Postoperative surgical complications/mortality occurred in 23%/3.8% (SM-PVR) versus 35%/4.1% (no SM-PVR); P=0.09/0.9. Analysis of long-term survival in all 165 patients included 41 with SM-PVR. Five-year survival rates were 15% in cancer of the pancreatic head, 22% in ampullary cancer, and 24% in distal bile duct cancer (P=0.02). Long-term survival was not influenced by the need for SM-PVR in any of the different tumor entities. In multivariate analysis, a positive resection margin (P<0.01, relative risk [RR]: 1.8, 95% confidence interval [CI]: 1.2–2.7), a histologically undifferentiated tumor (P=0.01, RR: 1.7, 95% CI: 1.1–2.5), and the tumor entity (P<0.01) were significant predictors of survival. Univariate survival analysis of the 110 patients with cancer of the pancreatic head revealed that a histologically undifferentiated tumor (P=0.05) and positive resection margins (P=0.02) were associated with a poorer survival. In multivariate analysis, the resection margin (P=0.02, RR: 5.1, 95% CI: 1.1–2.8) and a histologically undifferentiated tumor (P=0.05, RR: 3.8, 95% CI: 1.0–2.5) significantly influenced survival. After PD, perioperative morbidity and long-term survival in patients with SM-PVR were similar to those of patients without vein resection. In case of tumor adherence or infiltration, combined resection of the pancreatic head and the vein should always be considered in the absence of other contraindications for resection. Initial results were presented at the Forty-Fourth Annual Meeting of The Society for Surgery of the Alimentary Tract, Orlando, Florida, May 18–21, 2003 (poster).     

胰腺癌的早期诊断与外科处理

目的 探讨胰腺癌的早期诊断与外科处理。方法 回顾分析24例胰腺癌诊断和治疗情况。结果 24例胰腺癌中,胰头癌19例,胰体尾癌5例;经B超、CT诊断24例,MRI18例,MRCP8例,RECP12例,DSA3例,IOUS11例,FNAB17例;根治性切除4例,胆囊空肠内引流术13例,附加胃空肠吻合术6例,胆囊空肠双造口4例,瘤体内注射无水乙醇6例,胃十二指肠动脉区域化疗8例,PTCD3例。术后胰瘘1例,疼痛缓解18例,黄疸减退／消失14例,死亡1例,其余术后恢复良好。结论 可疑胰腺癌患,联合运用影像学、肿瘤标记物、穿刺检查等方法,才能提高早期诊断率。恰当的外科处理,术后辅助性区域放、化疗和免疫调节治疗,是提高胰腺癌患生存期、降低术后并发症和病死率的必要措施。     

Complications after pancreaticoduodenectomy for pancreatic cancer: a retrospective study

Postoperative complications, such as pancreatic fistulae, after pancreaticoduodenectomy for pancreatic cancers are associated with surgical outcomes of patients with pancreatic cancers. A total of 160 patients with pancreatic cancers undergoing pancreaticoduodenectomy were retrospectively analyzed. Patients were grouped into a fistulae group (n = 34) and a nonfistulae group (n = 126). The fistulae group had a significantly higher morbidity rate than the nonfistulae group (P < 0.0001), but hospital mortality was not different in both groups (P = 0.481). There was a higher incidence of intra-abdominal hemorrhage in patients with pancreatic fistulae than in those without fistulae. Two patients in fistulae group underwent reoperation. Patients with pancreatic fistulae had significantly longer hospital stay than those without fistulae. Pancreatic duct diameter, smoking, years of tobaccos consumption, preoperative jaundice, and surgical hours were associated with risk of fistulae on univariate analysis. In a multivariate analysis, diameter of pancreatic duct, surgical hours, and preoperative jaundice were independent risk factors of pancreatic fistulae. Incidence of pancreatic fistulae after pancreaticoduodenectomy is significantly influenced by the size of pancreatic duct diameter, surgical time, and preoperative jaundice. Early postoperative hemorrhage could be cautiously prevented. The survival is not significantly impacted by pancreatic fistulae.     

肠系膜上静脉／门静脉切除在胰腺癌根治切除中的临床价值探讨

目的探讨在胰十二指肠切除术中,为达到根治切除目的,联合肠系膜上静肪/门静脉（SMV／PV）切除的临床价值。方法回顾性分析1999年1月-2005年12月间天津医科大学附属肿瘤医院118例胰腺癌行胰十二指肠切除术患者,其中21例联合了不同程度的SMV／PV的切除,对两组患者的临床病理特征、并发症发生率、围手术期死亡率及预后进行分析。结果两组间在手术并发症、围手术期死亡率及术后生存率上比较无统计学差异。血管切除组中,共有8例患者术后病理证实SMV／PV受累,预后较差。但与同期未切除受累血管、断端阳性患者相比,血管切除组预后好于癌残留组（P〈0．01）。结论对于胰头癌局部浸润SMV／PV,但无远处转移的患者,应积极行手术切除。胰腺癌联合SMV／PV切除可以有效提高手术切除率,但并未增加术后并发症及围手术期死亡率。联合SMV／PV切除对提高胰腺癌的根治率和生存率有重要的意义。     

Is Reporting of Recurrence Data Important in Pancreatic Cancer?

Background: Therapeutic approaches to patients with pancreatic cancer have undergone a paradigm shift in recent years. However, little is known about the outcome of patients with recurrent pancreatic cancer who undergo treatment. The purpose of this study was to identify patients with recurrent pancreatic cancer and to determine whether treatment after recurrence had any effect on outcome.Methods: A review of all patients undergoing surgical resection with curative intent revealed 70 patients with documented recurrence and complete medical records. Patients were grouped into three categories: group 1 included those who received treatment after recurrence (n = 45), group 2 included those who were not offered treatment (n = 9), and group 3 included those with poor performance status who received no treatment (n = 16).Results: The median overall survival for the three groups was 26, 18, and 14.5 months for groups 1, 2, and 3, respectively (P < .00001). The median survival after recurrence was 10 months, 6 months, and 1 month, respectively, for the three groups (P < .0001).Conclusions: This is the first series we are aware of that compares the outcomes of patients who received treatment after recurrence of pancreatic cancer with the outcomes of those who received no treatment. In this series, it seems that patients who were well enough to tolerate additional therapy had a longer survival than those who received supportive care only. This may be important in the analysis of adjuvant therapy trials of pancreatic cancer with survival as an end point.     

胰腺癌扩大根治术中的血管处理

目的 探讨联合门静脉-肠系膜上静脉切除的胰腺癌扩大根治术的临床意义和手术方法 ,以及术中医源性血管损伤的处理方法 .方法 回顾性分析242例胰腺癌扩大根治术患者临床资料,所有患者分为三组,A组为门静脉/肠系膜上静脉切除组(n=51),B组为术中发生医源性血管损伤组(n=5),C组为未行血管处理组(n=186),比较三个组的手术时间、术中输血量、血管阻断时间、平均住院天数、术后并发症及术后生存分析.结果 三个组手术时间分别为(442.85±102.32)min、(348.62±92.31)min和(315.00±83.43)min,术中平均输血量为(1430.83±1092.43)ml、(1420.22±794.41 ml)和(928.19±571.57)ml,手术时间和术中输血量相比差异有统计学意义(P<0.05),平均住院天数、术后并发症发生率差异无统计学意义(P 0.05).合并门静脉/肠系膜上静脉切除的胰腺腺癌患者术后中位生存期18.4个月,不合并门静脉/肠系膜上静脉切除组的胰腺腺癌患者术后中位生存期16.1个月,生存分析两者无明显差异(P 0.05).51例联合血管切除的患者中,行血管壁部分切除7例,行血管节段切除44例,44例血管节段切除患者中38例行端端吻合,6例行间置移植物,血管切除长度平均(2.92±1.35)cm;5例术中医源性动脉损伤的血管分别为肝动脉1例,肠系膜上动脉1例,腹腔干3例,处理方式为4例行端端吻合,1例行局部修补.结论 积极合理的开展联合门静脉/肠系膜上静脉切除的胰腺癌扩大根治术可以提高手术切除率,改善患者生活质量.由于局部的解剖关系复杂,术中较易发生医源性血管损伤,应引起术者重视并加以正确处理.     

Palliation for pancreatic cancer

Background: Although laparoscopy reveals undetected metastases in many patients with pancreatic cancer, most surgeons have chosen to proceed directly with laparotomy in an attempt at resection or for palliation of biliary and gastric outlet obstruction. In an effort to overcome this limitation, this study attempted to determine the feasibility of laparoscopic cholecystojejunostomy and gastrojejunostomy. Methods: Under general anesthesia, seven pigs underwent laparoscopic cholecystojejunostomy and gastrojejunostomy using either a hand-sutured or the stapled/sutured technique. Results: Mean operating time was less with the stapled/sutured vs hand-sutured technique (150±21 vs 230±13 min, P<0.05). All animals recovered completely and there was no change in their weight or liver function tests as a result of the procedure. At sacrifice, all anastomoses were patent, although some were significantly narrowed in these unobstructed animals. Conclusions: These results suggest that simultaneous laparoscopic palliation of biliary and gastric outlet obstruction is feasible. We believe these results warrant further study in the clinical setting.Presented at the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), April, 1994, Nashville, TN, USA