胰头癌手术切除可能性的术前评价

目的　通过总结胰头癌病人的临床表现和影像学检查结果来评价手术切除的可能性。方法　总结 3 2例胰头癌病人的临床表现和CT、磁共振 (MR)检查结果 ,判断肿瘤是否已发生邻近浸润或远处转移 ,以此来评价其手术切除的可能性。结果　在 2 2例作CT检查的病例中 ,判断正确的为 17例 ,准确率为 77.3 %。作MR检查 9例 ,全部判断正确 ,准确率为 10 0 %。结论　某些特殊的临床表现和CT、MR检查对判断肿瘤是否发生邻近浸润或转移有较大价值 ,为术前评价手术切除的可能性提供依据。     

CT对胰头癌手术切除可行性的评估

作者对３０例胰头癌患者进行了术前ＣＴ扫描评估手术可切除性的前瞻性研究。结果显示；术前ＣＴ判断为可切除的１３例中，有１２例术中证实确能行根治性胰十二指肠切除术，准确率为９２．３％；而术前ＣＴ依据肠系膜上静脉或门静脉受侵，肿瘤过大侵及十二指肠以及肝或肝门淋巴结转移等判为不能切除的１７例均未能施行根治性胰十二指肠切除术，准确率达１００％，表明术ＣＴ检查对头癌能否施行根治性切除手术确有很好的预测价值。     

不可切除的胰头癌的综合治疗

胰腺癌的治疗虽以手术为主 ,但相当多的病人就诊时已属中晚期 ,而无法作根治性切除 ,胰头癌的切除率在 15 %左右 [1 ] 。所以 ,对大部分不可切除的胰头癌患者 ,必须寻找其它治疗方法 ,以延长患者生命 ,提高生存率 ,改善生命质量。1995年— 1997年间 ,我们对 30例不可收稿日期 :2 0 0 0 -0 1-0 3作者单位 :湖北省肿瘤医院 ,湖北　武汉　43 0 0 70切除的胰头癌患者行胆肠转流术 动脉区域化疗 放疗的综合治疗研究 ,现报道如下。1　临床资料1.1　全组 30例 ,男 2 6例 ,女 4例 ,男女之比 6 .5∶ 1。年龄 31岁～ 73岁 ,均龄 5 2岁。≥ 6 0岁者 2…     

区域性胰腺切除治疗胰头癌的现状

胰腺癌是常见的消化系统恶性肿瘤。其发病率在我国虽无确切统计,但据沈魁等调查全国１２个省、市、自治区２０家医院的资料表明,胰腺癌入院患者数呈逐年上升趋势。胰腺癌中３／４以上肿瘤发生于胰头。虽然手术切除是胰头癌唯一可获治愈的治疗手段,然临床所遇胰头癌患者大多属中晚期,以胰十二指肠切除（ＰＤ）作为胰头癌的标准术式,手术切除率仅１０％～２５％。即使根治切除,也有５０％以上患者有局部复发。在我国,多数临床资料报道术后５年生存率不足１０％。胰头癌的生物学特性,可较早发生周围淋巴结和神经丛的转移。当胰头癌≤２…     

胰头癌的根治性切除与适应证

迄今,胰十二指肠切除术依然是胰头癌治疗的主要手段,也是唯一有治愈可能的方法。近年来,由于手术技术和围手术期监护技术的发展,胰十二指肠切除术的并发症发生率和围手术期死亡率均有较大幅度的下降,大型医疗中心和专科医院的手术死亡率低于5％,并发症发生率低于30％,     

胰头十二指肠切除加胰十二指肠下静脉插管化疗治疗胰头癌：附10例报告

胰头十二指肠切除加胰十二指肠下静脉插管化疗治疗胰头癌（附１０例报告）刘广庆，孙喜波，刘令锁，李仕金，亓空明，王金勇我们自１９８９年６月～１９９４年３月对能切除的胰头癌１０例在行胰头十二指肠切除的同时经胰十二指肠下静脉插管至肠系膜上静脉化疗，效果满意，...     

不能切除的胰头癌二步切除长期生存1例报告

不能切除胰头癌缺乏有效的治疗方法[1,2],我们采用动脉灌注化疗与瘤内注射的综合治疗,使l例不能切除胰头癌转变为可切除癌,获得二步切除,患者获得治愈,生存时间超过13年,现报告如下.     

胰头癌切除生存率及近期死亡的主要原因

胰头十二指肠切除(pancreatico—duod enectomy),又称Whipple氏手术。Whipple氏于1933年首次胰十二指肠切除以来,随着手术技巧和方法不断改进,遵循手术模式者颇多,对胰头切除的量和胰周围淋巴结清除范围重视不够,是影响生存率的主要原因。尤其,     

不能切除的胰头癌置泵化疗46例体会

作者报告了46例经手术证实不能切除的胰头癌，在行姑息性手术的同时通过置胰十二指肠上动脉泵进行化疗，结果表明：肿瘤缩小50％以上者13例，其中4例术后3－6个月行二期手术切除癌肿，肿瘤明显缩小者21例，肿瘤大小变化不大，病情稳定者9例，肿瘤增大，病情恶化者3例，经随访、全组1、2及3年生存率分别为80．4％、45．7％及30．4％，平均生存期为25．7个月，提示疗法是不能切除胰头痛的一种有效方法，具有能重复使用，化疗方便，疗效确切的优点。     

胰头癌放射治疗1例

1临床资料患者,男,45岁,胰腺癌剖腹探查术后。患者于2006年8月出现阵发性上腹部绞痛,伴有恶心,就诊于当地医院诊断为急性胆囊炎,经抗炎对症治疗后,症状反复发作。2007年4月患者再次出现阵发性上腹部绞痛,于当地医院对症治疗疗效差,后出现巩膜、皮肤黄染,     

Non-icteric pancreas head carcinoma fares worse than icteric pancreas head carcinoma.

A total of 22 patients with non-icteric pancreas head carcinoma were retrospectively compared with 61 patients with icteric pancreas head carcinoma. No significant difference was found regarding age, sex, greatest diameter, macroscopic type, microscopic type, stage, lymphatic permeation, perineural infiltration, venous invasion, lymph node metastasis, and the presence of cancer cells at the surgical margins. The main location of pancreas head carcinoma could be divided into two sites: the superior (pericholedochal), and inferior or distal (excholedochal) areas of the pancreas head. Sixteen (73%) of the 22 non-icteric pancreas head carcinomas were located in the inferior or distal area (excholedochal), while 28 (46%) of the 61 icteric pancreas head carcinomas were situated in the superior portion (pericholedochal) (P less than 0.05). One (5%) of the 22 non-icteric pancreas head carcinomas was small pancreas carcinoma, compared with 11 (18%) of the 61 icteric pancreas head carcinomas. The cumulative 2-year and 4-year survival rates of the 22 patients with non-icteric pancreas head carcinoma were significantly worse than those of the 61 patients with icteric pancreas head carcinoma [7.9% vs. 24.6% (P less than 0.05) and 0% vs. 13.4% (P less than 0.01)]. These findings suggest that non-icteric pancreas head carcinomas normally arise in an area far from the biliary tree, and include a greater number of large tumors. Any resulting difficulty and delay in the diagnosis and treatment of this disease will usually lead to a worsening of the clinical course of non-icteric pancreas head carcinoma.     

扩大淋巴结清扫对胰头癌患者预后效果的观察

目的 探讨扩大淋巴结清扫对胰头癌患者疗效及预后的影响.方法 回顾性分析136例胰头癌患者的临床资料,根据治疗方法的不同将患者分为扩大组和常规组,每组各68例.常规组患者接受胰十二指肠切除术及常规淋巴结清扫,扩大组患者接受胰十二指肠切除术及扩大淋巴结清扫.比较两组患者的术中、术后指标及并发症发生率.结果 扩大组患者的手术时间长于常规组,术中出血量多于常规组(P﹤0.05).扩大组患者术后胃排空延迟的发生率高于常规组,阳性淋巴结检出数多于常规组,原位癌复发率低于常规组,差异均有统计学意义(P﹤0.05).术后两组患者吻合口瘘、腹腔出血及腹腔感染的发生率比较,差异均无统计学意义(P﹥0.05).随访5~33个月,两组患者的中位生存时间比较,差异无统计学意义(P﹥0.05).结论 对于行胰十二指肠切除术的胰头癌患者,扩大淋巴结清扫范围可提高阳性淋巴结检出率,降低原位癌复发率,但对患者的远期疗效无明显影响,同时加重了对患者机体的损伤,延长了手术时间,增加了术中出血量及胃排空延迟的发生率,不建议常规对患者采用扩大淋巴结清扫术,尤其是年老及身体状况较差者.     

Primary lymphoma of the head of the pancreas

Primary and isolated lymphoma of the head of pancreas with secondary involvement of the lungs and obstructive jaundice, in a 31-year-old postpartum woman, is described. The histological diagnosis was diffuse histiocytic lymphoma. Chemotherapeutic treatment resulted in complete remission of the tumor. During therapy a pseudocyst of the pancreas developed and a gastrocystostomy was performed. This is the second reported case of primary pancreatic lymphoma in the English medical literature.     

CT在判断可切除性胰头癌手术中的价值探讨

经手术、病理证实的胰头癌５９例。通过对术前ＣＴ判断肿瘤的可切除性和术后比较，其结果可切除的符合率为６４．７％，不可切除的符合率为９２．８％。ＣＴ显示肠系膜上动脉、腹腔动脉增粗，肿瘤包裹血管、血管中癌栓形成为肿瘤不可切除的可靠征象；肝转移、腹水为不可切除的完全可靠的征象，但小的转移性肝癌不易发现；淋巴结肿大并不是转移的特异征象；血管部分与肿瘤接触，脂肪层消失，有时不易区别是否为肿瘤授润，对判断手术可     

彩色多普勒血流显象对胰腺癌的诊断意义

目的　探讨彩色超声对胰腺癌的诊断价值。方法　常规扫查胰腺及其周围结构 ,发现肿瘤后引入彩色多普勒技术 ,观察肿瘤内部及周边的血流分布 ,胰周围血管的走行及血流状态 ,并注意局部有无肿大淋巴结 ,邻近脏器有无受侵。结果　 33例胰腺癌中 ,胰头部 2 3例 ,误诊3例 ;全胰腺 2例 ,误诊 1例 ;胰体尾部 8例 ,全部诊断正确 ,诊断符合率 87.9% (2 9/ 33)。 CDFI观察肿瘤周边无“花蓝样”特征性彩色血流包绕 ;超声对胰周围淋巴结及重要血管周围淋巴结受侵的诊断率为 83.3% (1 0 / 1 2 ) ;对重要血管受侵的诊断率为 71 .4% (5/ 7)。结论　 CDFI对胰腺癌浸润周围血管的诊断极为有用对癌肿病灶的确定仅起辅助作用。     

A case of breast cancer metastatic to the head of the pancreas

A case of breast cancer that metastasized to the head of the pancreas 6 years and 8 months after mastectomy is reported. The pancreas head metastasis was associated with general fatigue and obstructive jaundice. The serum levels of CEA, CA15-3 and NCC-ST-439, tumor markers of breast cancer, were within normal limits, but CA15-3 was immunohistochemically demonstrated in the resected metastatic lesion, in a manner similar to lobular carcinoma of the breast.     

Biliary and duodenal bypass for carcinoma of the head of the pancreas

A review was undertaken of 66 patients having palliative bypass surgery for carcinoma of the head of the pancreas. A second laparotomy for relief of duodenal obstruction was necessary in six of 29 (20%) of the patients who did not have gastroenterostomy performed initially, but late gastric outlet obstruction occurred only once in 37 patients having an initial gastroenterostomy (P less than 0.05). Cholecystojejunostomy failed to provide permanent biliary bypass in 14 of 53 (26%) patients, compared to successful drainage in all 13 patients having anastomosis of the common hepatic duct to the jejunum (P less than 0.05). In seven patients cholecystojejunostomy was performed when the cystic duct was already obstructed by tumour. Therefore prophylactic gastrojejunostomy is recommended as a routine. The gallbladder should only be used for biliary bypass when appropriate contrast x-rays have demonstrated the patency of the cystic duct.     

The continuing problem of carcinoma of the pancreas

The courses of 208 patients with adenocarcinoma of the pancreas were reviewed. The lesion was located in the head of the pancreas in 142 patient, (68%) and of these, in 22 patients the diagnosis was confirmed histologically at postmortem examination; 21 patients underwent laparotomy and biopsy with a 33% operative mortality and a 3.4-month average survival; 89 patients underwent biliary and/or gastric bypass with a 24% mortality and 4.8-month average survival; 10 patients underwent pancreaticoduodenectomy with a 20% mortality and 14.6-month average survival. The lesion was located in the body or tail of the pancreas in 77 patients (32%); and, of these, 15 patients had histologic confirmation of clinical diagnoses at postmortem examination; 19 patients underwent biopsy of extra-abdominal metastases and survived an average of 1.4 months; 27 patients underwent laparotomy and biopsy with a 26% operative mortality and 3.5-month average survival; 4 patients underwent gastric and/or biliary bypass with a 50% mortality and 4.5-month average survival; one patient underwent noncurative distal pancreatectomy and survived 1 month postoperatively. No patient was cured of his disease. Of the 55 operative survivors of biliary bypass alone for carcinoma of the head of the pancreas, 5 (9%) required subsequent gastroenterostomy for duodenal obstruction.     

Papillary-cystic carcinoma of the pancreas

Papillary-cystic carcinoma of the pancreas is an extremely rare tumor which occurs in young adults, may invade locally, but is late to metasta-size. As opposed to adenocarcinoma of the pancreas, portal vein invasion should not be included as a criteria for nonresectability. In the absence of metastatic disease, pancreatectomy combined with portal vein resection, if invasion is present, may offer a good prognosis and comparatively long survival time.