腹腔镜、内镜联合治疗晚期胰头癌的临床研究(附193例报告)

目的:探讨腹腔镜、内镜联合治疗晚期胰头癌,延长患者生存期并改善生活质量的方法与效果。方法:2000年12月至2008年12月我院为193例不能根治性切除的晚期胰头癌患者施行内镜金属支架和腹腔镜胆囊空肠、胃空肠内引流手术。结果:内镜治疗成功率达84.5%(163/193),内镜治疗失败或伴有十二指肠排空障碍者行腹腔镜内引流术成功率达100%(52/52)。术后患者黄疸消退,肝功能好转,能经口进食,提高了生活质量。内镜术后8例(4.9%)发生相关并发症,其中胆道感染5例(3.1%),急性水肿性胰腺炎3例(1.8%)。内镜治疗术后生存期最短3个月,最长37个月,平均(13.1±2.7)个月。腹腔镜内引流术后5例(9.6%)发生相关并发症,其中切口感染3例(5.8%),胃肠排空障碍2例(3.8%)。术后生存期最短2个月,最长21个月,平均(12.3±2.2)个月。结论:对于失去根治切除机会的晚期胰头癌患者,有针对性地选择内镜金属支架和腹腔镜胆肠、胃空肠吻合术,可达到微创、有效的姑息治疗效果,能较好地提高患者的生活质量,延长生存时间。

Clinical study on combination of laparoscopic and endoscopic treatment for late carcinoma of pancreas head:with a report of 193 cases

Objective:To explore the method and effect of combined endoscopic and laparoscopic treatment for late carcinoma of pancreas head in order to improve quality of life and lengthen the life of the patients.Methods:One hundred and ninety-three cases of unresectable late carcinoma of pancreas head diseases were treated with laparoscopic cholecystojejunostomy and laparoscopic gastrojejunostomy combined with endoscopic biliary duct metallic stents placement from Dec.2000 to Dec.2008.Results:Endoscopy was successful in 163 patients with successful rate 84.5%(163/193).For patients underwent unsuccessful endoscopy or with malignant obstruction of duodenum,the success rate of laparoscopic cholecystojejunostomy and gastric bypass was 100%(52/52).Jaundice and hepatic functions obviously improved,oral nutrition was regained,the quality of life improved too.Complications occurred in 8 patients who had been treated by endoscopy(4.9%),including infection of biliary duct in 5 cases(3.1%)and acute oedema pancreatitis of 3 cases(1.8%);Average survival time was(13.1±2.7) months(range 3-37 months) after endoscopic treatment.Complications occurred in 5 patients who had been treated by laparoscopy(9.6%),including 3 infection of incisional wound(5.8%),and digestive tract evacuation disorder in 2 cases(3.8%).Average survival time was(12.3±2.2) months(range 2-21 months) after laparoscopic treatment.Conclusions:Laparoscopic cholecystojejunostomy and gastrojejunostomy combined with endoscopic metallic stents placement is a effective and minimally invasive technique for patients with unresectable late carcinoma of pancreas head.The quality of life can be improved effectively and the life of the patients can be lengthened.