CAJ | 학술논문

目的分析不合并消化道梗阻的晚期胰头癌的临床资料,探讨治疗策略.方法回顾性分析2001年1月至2010年12月收治的441例不伴消化道梗阻的晚期胰头癌患者的临床资料.结果所有患者均行手术治疗,其中行胆囊-空肠Roux-en-Y吻合术(A组)101例,胆总管-空肠Rouxen-Y吻合术(B组)133例,胆囊-空肠Roux-en-Y吻合+胃-空肠吻合术(C组)83例,胆总管-空肠Roux-en-Y吻合+胃-空肠吻合术(D组)124例.术后A、C两组分别有7.9％及6.0％的患者再发胆道梗阻,A、B两组分别有8.9％及8.3％的患者出现消化道梗阻,四组患者生存时间差异无统计学意义(F=1.933,P=0.123).结论对不合并消化道梗阻的晚期胰头癌患者,胆总管空肠吻合术能有效预防术后再次胆道梗阻；预防性胃空肠吻合术能显著降低患者术后消化道梗阻发生率,而胆囊-空肠吻合术仅可在患者一般情况较差或胆管吻合条件不具备时谨慎选用.
목적 분석불합병소화도경조적만기이두암적림상자료,탐토치료책략.방법 회고성분석2001년1월지2010년12월수치적441례불반소화도경조적만기이두암환자적림상자료.결과 소유환자균행수술치료,기중행담낭-공장Roux-en-Y문합술(A조)101례,담총관-공장Rouxen-Y문합술(B조)133례,담낭-공장Roux-en-Y문합+위-공장문합술(C조)83례,담총관-공장Roux-en-Y문합+위-공장문합술(D조)124례.술후A、C량조분별유7.9％급6.0％적환자재발담도경조,A、B량조분별유8.9％급8.3％적환자출현소화도경조,사조환자생존시간차이무통계학의의(F=1.933,P=0.123).결론 대불합병소화도경조적만기이두암환자,담총관공장문합술능유효예방술후재차담도경조；예방성위공장문합술능현저강저환자술후소화도경조발생솔,이담낭-공장문합술부가재환자일반정황교차혹담관문합조건불구비시근신선용.
Objective To explore the optimal management strategies for unresectable advanced pancreatic head carcinoma without preoperative gastric outlet obstruction(GOO).Methods Clinical data of 441 cases of advanced pancreatic head carcinoma without GOO undergoing surgery from Jan 2001 to Dec 2010 were analyzed retrospectively.Results Among the 441 cases of advanced pancreatic head carcinoma without GOO,101 patients received simple Roux-en-Y cholecystojejunostomy (group A),133 patients received simple Roux-en-Y choledochojejunostomy (group B),83 patients received Roux-en-Y cholecystojejunostomy combined gastrojejunostomy(group C) and the other 124 patients received Roux-en-Y choledochojejunostomy combined gastrojejunostomy (group D).The postoperative recurrent obstructive jaundice rates were 7.9％ and 6.0％ in group A and C,respectively; the postoperative de novo GOO rates were 8.9％ and 8.3％ in group A and B,respectively; there were no differences in median survivals among the four groups (F =1.933,P =0.123).Conclusions Choledochojejunostomy is effective for the reduction of recurrent obstructive jaundice for advanced pancreatic head carcinoma patients without GOO,combined prophylactic gastrojejunostomy during surgical biliary drainage could decrease the rate of postoperative GO0.Cholecystojejunostomy could be only applied for patients with poor health or when choledochojejunostomy is a taboo.