无黄疸型胰头癌外科治疗临床研究.docVIP

无黄疸型胰头癌外科治疗临床研究【中图分类号】R736 【文献标识码】A 【文章编号】1672－3783(2011)09－0020－02 【摘要】目的 探讨无黄疸型胰头癌外科治疗的临床特点。方法 回顾性分析近十年我院收治的胰头癌患者63例，根据有无黄疸症状，将病例分为黄疸组、无黄疸组。统计两组在症状、体征、实验室检查、影像学检查、疗效及预后等方面的差异。结果 凡上腹部胀痛不适、烧灼、纳差、消瘦、恶心、呕吐等症状，经治疗不见好转或加重，应进行B超筛选，如发现胆、胰管扩张，胰头增大或肿块阴影者，进一步行ERCP、CT或B超引导下穿刺细胞学检查。结论 无黄疸型胰头癌患者可提高切除率并延长生存期。? 【关键词】无黄疸型胰头癌；外科；治疗；中位生存率 【Abstracts】Objective To discuss clinical characteristics of the surgical treatment of non-jaundiced carcinoma of head of pancreas. Methods Retrospectively analyze 63 patients with carcinoma of head of pancreas who were treated in the decade. They were classified into jaundice group and non jaundice group according to the status of clinical symptom. Statistical analysis was made to discover where there were differences in the symptom, physical sign, laboratory examination, imaging examination, curative effect and prognosis between these two groups. Results Once the symptoms of upper abdominal distending pain, burning, anorexia, marasmus, nausea, and vomit emerged, and were not recovered or even worsen, type-B ultrasonic should be used to make a filtration. If cholangiectasis, ductal ectasia, enlargement of the head of pancreas or mass shadow were discovered, ERCP, CT, and cytologic examination under the guide of type-B ultrasonic should be applied further more. Conclusions The treatment of non-jaundiced carcinoma of head of pancreas could improve the removal rate and extend the survival time. ? 【Key Words】non-jaundiced carcinoma of head of pancreas, surgery, treatment, median, survival rate 黄疸是胰头癌的常见临床表现之一，虽然大多患者都以黄疸为首发症状就诊，但仍有10%-20％ 的患者在病程中无黄疸出现，即无黄疸型胰头癌，这在临床上很容易被误诊或漏诊［1］。本研究收集我院1999年以来诊断的63例胰头癌患者资料，探讨并评价无黄疸型胰头癌患者外科治疗的临床特点。? 1 对象与方法? 1.1 一般资料:本组患者共63例，其中男35例，女28例，最大年龄75岁，最小年龄49岁，平均年龄（66±7）岁，首发症状：上腹部隐痛不适29例，食欲减退、体重降低20例，恶心呕吐14例。所有病人在人院时均行B超、CT检查。所有患者根据有无黄疸，将病例分为黄疸组（38例）和无黄疸组（25例）。? 1.2 手术方法:63例患者中行胰十二指肠完全切除术24例，其中黄疸组16例、无黄疸组8例。其余患者由于CA19.9超过300 U/L，未采取切除术。? 1.3 统计学分析:采用SPSS14.0统计软件进行分析，计量资料以（）表示，两组均数比较采用Student’s t检验，计数资料