胰腺及壶腹周围癌诊治40年经验总结

本文分析40年来胰腺及壶腹周围癌诊断和治疗的进展。以1978～1989年手术治疗的67例胰腺及壶腹周围癌和1990年～1991年6月的9例与作者1964年报告的90例结果做了对照。1.1977年以前主要诊断根据是临床梗阻性黄疸。1978年以后B超、ERCP、PTC、CT和十二指肠镜检查等已普遍应用,多能确定肿瘤位置或提出异常所在。2.手术切除率由31.1％提高到77.8％。3.术后并发病和死亡原因,早年多因直接与手术有关的并发病,而近年则多为非直接与手术有关的原因,如心肌梗塞、ARDS。4.术后5年绝对生存率由12.5％升到21.1％。3例已健康生存14年以上。

Regional Advances in the Diagnosis and Treatment of Periampullary Carcinoma during the Past 40 Years in Tianjin

The authors analysed cases of periampullary carcinoma operated upon at Tianjin First Central Hospi- tal,among them 67 cases treated during 1978-1989 and 9 eases during 1990-June 1991. The result was compared with that of the 90 cases reported by the senior author (Huang) in 1964. Considerable advances were evidenced in the diag- nosis and treatment of the disease over the past 40 years. Before 1977,the diagnosis was based mainly on clinical history and physical signs such as obstructive jaundice. Since 1978 B-US,ERCP,PTC,CT and duodenoscopy were adopted with the result that the tumors' localization was iden- tified with greater certainty. The resectability rate (Whipple's operation) rose from 31.1% to 77.8%. Most of the postoperative complications and deaths in the early period were due to complications directly related to surgery , however, in the latter period most of the deaths were due to causes other than surgery such as myocardial in- farction or ARDS. The 5-year survival rate was raised from 12.5% to 21.1%. Three of the patients are still living and well more than 14 years after operation.