• 成都軍區(qū)總醫(yī)院全軍普通外科中心(四川成都 610083);

目的評(píng)價(jià)姑息性外科手術(shù)在無法切除的晚期壺腹周圍癌治療中的作用。方法對(duì)我院1998年6月至2008年6月期間接受姑息性外科手術(shù)治療的292例晚期壺腹周圍癌患者的臨床資料進(jìn)行回顧性分析。結(jié)果292例患者中，術(shù)后死亡率及并發(fā)癥發(fā)生率分別為0.7%(2/292)及24.0%(70/292)，平均存活時(shí)間10.3個(gè)月。有243例(83.2%)患者術(shù)后總膽紅素完全降至正常，有39例(13.4%)患者總膽紅素較術(shù)前降低一半以上，總有效率為96.6%(282/292)。結(jié)論對(duì)于無法切除的晚期壺腹周圍癌，姑息性外科手術(shù)是一種安全、有效的治療方法，手術(shù)方式以Roux-en-Y膽管空腸吻合聯(lián)合胃空腸吻合為宜。

引用本文： 陳濤,湯禮軍,田伏洲,向珂,石力,崔建峰. 姑息性外科手術(shù)在晚期壺腹周圍癌治療中的作用. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(4): 423-425. doi: 復(fù)制

1. Watanapa P, Williamson RC. Surgical palliation for pancreatic cancer: developments during the past two decades [J]. Br J Surg, 1992, 79(1): 820.
2. Katsinelos P, Paikos D, Kountouras J, et al. Tannenbaum and metal stents in the palliative treatment of malignant distal bile duct obstruction: a comparative study of patency and costeffectiveness [J]. Surg Endosc, 2006, 20(10): 15871593.
3. 龔彪. 經(jīng)內(nèi)鏡膽道金屬支架引流術(shù)治療惡性膽道梗阻的價(jià)值-附786例報(bào)告 [J]. 中國消化內(nèi)鏡, 2007, 1(1): 2022.
4. 勾承月, 秦鳴放, 王慶, 等. 膽道支架介入治療惡性膽道梗阻136例臨床分析 [J]. 中國微創(chuàng)外科雜志, 2010, 10(5): 412414.
5. 辛波, 張林波, 姜喜遠(yuǎn), 等. 惡性梗阻性黃疸介入治療與手術(shù)引流比較 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(3): 233236.
6. 范震, 張嘯, 張?bào)泺P, 等. ERCP放置膽管內(nèi)支架姑息治療難以切除的惡性膽管梗阻 [J]. 現(xiàn)代消化及介入治療, 2007, 12(1): 13.
7. Dahlstrand U, Sandblom G, Eriksson LG, et al. Primary patency of percutaneously inserted selfexpanding metallic stents in patients with malignant biliary obstruction [J]. HPB (Oxford), 2009, 11(4): 358363.
8. Kahaleh M, Tokar J, Conaway MR, et al. Efficacy and complications of covered Wallstents in malignant distal biliary obstruction [J]. Gastrointest Endosc, 2005, 61(4): 528533.
9. Lee CK, Barrios B, Bjarnason H. Biliary tree malignancies: the University of Minnesota experience [J]. J Surg Oncol, 1997, 65(4): 298305.
10. Lesurtel M, Dehni N, Tiret E, et al. Palliative surgery for unresectable pancreatic and periampullary cancer: a reappraisal [J]. J Gastrointest Surg, 2006, 10(2): 286291.
11. Singh S, Sachdev AK, Chaudhary A, et al. Palliative surgical bypass for unresectable periampullary carcinoma [J]. Hepatobiliary Pancreat Dis Int, 2008, 7(3): 308312.
12. Kuhlmann KF, van Poll D, de Castro SM, et al. Initial and longterm outcome after palliative surgical drainage of 269 patients with malignant biliary obstruction [J]. Eur J Surg Oncol, 2007, 33(6): 757762.
13. 夏焱, 朱玉華, 張彪. 經(jīng)內(nèi)鏡放置自膨式不帶膜金屬支架治療膽管中下段惡性狹窄的療效觀察 [J]. 中國普外基礎(chǔ)與臨床雜志, 2004, 11(2): 151153.
14. 李海洋, 孫誠誼, 潘耀振, 等. 不同途徑膽道支架置入治療惡性梗阻性黃疸42例回顧分析 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(4): 300303.
15. Kim HO, Hwang SI, Kim H, et al. Quality of survival in patients treated for malignant biliary obstruction caused by unresectable pancreatic head cancer: surgical versus nonsurgical palliation [J]. Hepatobiliary Pancreat Dis Int, 2008, 7(6): 643648.
16. Lillemoe KD, Cameron JL, Hardacre JM, et al. Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective randomized trial [J]. Ann Surg, 1999, 230(3): 322328.
17. Shyr YM, Su CH, Wu CE, et al. Prospective study of gastric outlet obstruction in unrestable periampillary adenocarcinoma [J]. World J Surg, 2000, 24(1): 6065.
18. Liu YB, Huang L, Xian ZY, et al. Surgical treatment of patients with intermediateterminal pancreatic cancer [J]. World J Gastroenteral, 2006, 12(5): 765767.
19. Van Heek NT, De Castro SM, van Eijck CH, et al. The need for a prophylactic gastrojejunostomy for unresectable periampullary cancer: a prospective randomized multicenter trial with special focus on assessment of quality of life [J]. Ann Surg, 2003, 238(6): 894905.
20. 付金強(qiáng), 雷正明. 預(yù)防性胃腸轉(zhuǎn)流在晚期壺腹周圍癌外科治療中的價(jià)值 [J]. 中華普通外科學(xué)文獻(xiàn)(電子版), 2007, 1(2): 6774.
  1. 1. Watanapa P, Williamson RC. Surgical palliation for pancreatic cancer: developments during the past two decades [J]. Br J Surg, 1992, 79(1): 820.
  2. 2. Katsinelos P, Paikos D, Kountouras J, et al. Tannenbaum and metal stents in the palliative treatment of malignant distal bile duct obstruction: a comparative study of patency and costeffectiveness [J]. Surg Endosc, 2006, 20(10): 15871593.
  3. 3. 龔彪. 經(jīng)內(nèi)鏡膽道金屬支架引流術(shù)治療惡性膽道梗阻的價(jià)值-附786例報(bào)告 [J]. 中國消化內(nèi)鏡, 2007, 1(1): 2022.
  4. 4. 勾承月, 秦鳴放, 王慶, 等. 膽道支架介入治療惡性膽道梗阻136例臨床分析 [J]. 中國微創(chuàng)外科雜志, 2010, 10(5): 412414.
  5. 5. 辛波, 張林波, 姜喜遠(yuǎn), 等. 惡性梗阻性黃疸介入治療與手術(shù)引流比較 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(3): 233236.
  6. 6. 范震, 張嘯, 張?bào)泺P, 等. ERCP放置膽管內(nèi)支架姑息治療難以切除的惡性膽管梗阻 [J]. 現(xiàn)代消化及介入治療, 2007, 12(1): 13.
  7. 7. Dahlstrand U, Sandblom G, Eriksson LG, et al. Primary patency of percutaneously inserted selfexpanding metallic stents in patients with malignant biliary obstruction [J]. HPB (Oxford), 2009, 11(4): 358363.
  8. 8. Kahaleh M, Tokar J, Conaway MR, et al. Efficacy and complications of covered Wallstents in malignant distal biliary obstruction [J]. Gastrointest Endosc, 2005, 61(4): 528533.
  9. 9. Lee CK, Barrios B, Bjarnason H. Biliary tree malignancies: the University of Minnesota experience [J]. J Surg Oncol, 1997, 65(4): 298305.
  10. 10. Lesurtel M, Dehni N, Tiret E, et al. Palliative surgery for unresectable pancreatic and periampullary cancer: a reappraisal [J]. J Gastrointest Surg, 2006, 10(2): 286291.
  11. 11. Singh S, Sachdev AK, Chaudhary A, et al. Palliative surgical bypass for unresectable periampullary carcinoma [J]. Hepatobiliary Pancreat Dis Int, 2008, 7(3): 308312.
  12. 12. Kuhlmann KF, van Poll D, de Castro SM, et al. Initial and longterm outcome after palliative surgical drainage of 269 patients with malignant biliary obstruction [J]. Eur J Surg Oncol, 2007, 33(6): 757762.
  13. 13. 夏焱, 朱玉華, 張彪. 經(jīng)內(nèi)鏡放置自膨式不帶膜金屬支架治療膽管中下段惡性狹窄的療效觀察 [J]. 中國普外基礎(chǔ)與臨床雜志, 2004, 11(2): 151153.
  14. 14. 李海洋, 孫誠誼, 潘耀振, 等. 不同途徑膽道支架置入治療惡性梗阻性黃疸42例回顧分析 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(4): 300303.
  15. 15. Kim HO, Hwang SI, Kim H, et al. Quality of survival in patients treated for malignant biliary obstruction caused by unresectable pancreatic head cancer: surgical versus nonsurgical palliation [J]. Hepatobiliary Pancreat Dis Int, 2008, 7(6): 643648.
  16. 16. Lillemoe KD, Cameron JL, Hardacre JM, et al. Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective randomized trial [J]. Ann Surg, 1999, 230(3): 322328.
  17. 17. Shyr YM, Su CH, Wu CE, et al. Prospective study of gastric outlet obstruction in unrestable periampillary adenocarcinoma [J]. World J Surg, 2000, 24(1): 6065.
  18. 18. Liu YB, Huang L, Xian ZY, et al. Surgical treatment of patients with intermediateterminal pancreatic cancer [J]. World J Gastroenteral, 2006, 12(5): 765767.
  19. 19. Van Heek NT, De Castro SM, van Eijck CH, et al. The need for a prophylactic gastrojejunostomy for unresectable periampullary cancer: a prospective randomized multicenter trial with special focus on assessment of quality of life [J]. Ann Surg, 2003, 238(6): 894905.
  20. 20. 付金強(qiáng), 雷正明. 預(yù)防性胃腸轉(zhuǎn)流在晚期壺腹周圍癌外科治療中的價(jià)值 [J]. 中華普通外科學(xué)文獻(xiàn)(電子版), 2007, 1(2): 6774.