胰腺癌的临床综合治疗(附67例分析)

目的探讨胰腺癌的早期诊断及综合治疗方法及其疗效，以进一步提高胰腺癌的整体治疗。方法回顾性分析广西壮族自治区肿瘤医院肝胆乳腺外科1998年至2003年综合治疗的67例胰腺癌患者，36例病人给予外科手术治疗，其中11例行根治性胰十二指肠切除术。20例行胆管或胆囊空肠吻合内引流术，5例行剖宫探查手术。对不能手术治疗的31例运用综合治疗的手段。包括胆管支架，血管介入治疗，全身化疗，腹腔灌注化疗，放射治疗，高能聚焦治疗和中医抗癌治疗等。结果本组病人随访至．2003年4月。11例胰十二指肠切除术后病人，术后平均生存14个月。手术切除率为16．4％，1年生存率为54．5％。20例胆管内引流治疗者，术后生存平均为10个月。5例手术探查发现胃十二指肠韧带被肿瘤浸润无法行姑息性胆管内外引流术，术后平均生存2．5个月。非手术综合治疗31例，平均生存4．5个月。占本组病人46．2％。结论目前提高胰腺癌的早期诊断率并给予以手术为主的综合治疗仍是胰腺癌治疗的主要手段。应用合理的综合治疗措施可提高病人的生存质量，延长生存时间，减轻痛苦，值得临床推广应用。

Comprehensive therapy of pancreatic carcinoma- a report of 67 cases

Objective To investigate the methods of early diagnosis and comprehensive treatment on pancreatic carcinoma,to improve the effect of the treatment.Methods 67 cases of pancreatic carcinoma that received comprehensive treatment in our hospital from 1998 to 2003 were analyzed retrospectively.31 cases of them were surgically treated,which included 11 cases that received radical pancreaticoduodenectomy,20 cases that received bile duct-or gallbladder-intestinal anastomosis of internal drainage,and 5 cases that received laparotomy only.The other 36 cases that could not treated surgically received comprehensive treatment such as bile duct stents,interventional therapy,chemoradiation therapy,Chinese medicine,and so on.Result The rate of surgical excision was 16.4%(11/67).Among these 11 cases that received pancraticoduodenectomy,the average surviving period was 14 months until April 2003,and the one-year surviving rate was 54.5%.The average surviving periods of the 20 cases that received bile duct-or gallbladder-intestinal anastomosis of internal drainage and the 5 cases that recerved laparotomy were 10 and 2.5 months respectively.The 31 cases (46.2% of the whole group) that could not treated surgically but only received comprehensive treatment had the average surviving periods of 4.5 months.Conclusion Early diagnosis and surgical-predominant comprehensive therapy should be the principal method for treating pancreatic carcinoma presently.Application of various reasonable comprehensive treatments can extend surviving period and improve living quality for the patients.