内镜、腹腔镜联合治疗晚期胰腺癌的临床研究
详细信息    本馆镜像全文|  推荐本文 |  |   获取CNKI官网全文
摘要
目的:探讨ENBD在腹腔镜胆肠吻合术中的作用。方法:2000年1月至2003年12月间,对15例不能切除的晚期胰腺癌患者行腹腔镜胆囊空肠吻合(Laparoscopic Cholecystojejunostomy,LCJS)、腹腔镜胃空肠吻合术(Laparoscopic gastrojejunostomy),10例行开腹胆肠、胃肠吻合术。术前两组患者均常规行ENBD减黄治疗,观察患者黄疸消退情况和肝功能改善情况,作术前术后比较,作相应统计学处理。同时观察BD管在胆肠内引流术中、术后的作用。结果:患者ENBD术后黄疸逐渐消退,肝功能异常指标较术前恢复。BD管在术中有降低手术并发症的作用,术后通过BD管造影可了解胆肠吻合口情况。结论:ENBD联合腹腔镜胆肠吻合术在治疗不能切除的晚期胰腺癌中可降低手术并发症,提高手术的安全性。
Objective To explore the effect of ENBD in process of laparoscopic cholecystojejunostomy. Methods From January 2000 to december 2003, ENBD was performed to relieve jaundice before laparoscopic cholecystojejunostomy in 15 patients and corresponding operation cholecystojejunostomy in 10 patients in unresectable late carcinoma of pancreas. To observe regression of the jaundice and amelioration of the Liver function. Comparing the markers on the preoperative period and postoperative period. Making statistics analysis simultaneously. Observing the effects of the BD duct in process of choleric-enteroic by-pass. Results The jaundice of the patients extinct gradually on the postoperative period, abnormal parameters of the Liver function were improved comparing with those on the preoperative period. The BD duct be able to cut down the complications of operations.We can get the message of the stoma in cholecysto-jejunum to carry out the cholangiography through the BD duct on the preoperative period. Conclusions For tr
    eatments of
    
    
    unresectable late carcinoma of pancreas, combined ENBD and laparoscopic cholecystojejunostomy can cut down the complications of the operation, rise the reliability of the operation.
引文
1.何三光.梗阻性黄疸减黄的利弊.中国实用外科杂志,1996;16(1):11~14
    2.李永国,李清龙.梗阻性黄疸对血液及免疫系统的影响.中国实用外科杂志,1996;16(1):17~18
    3.宋继昌,宋建章.胆红素代谢与黄疸.吴咸中主编.腹部外科实践.第三版.天津:天津科学技术出版社,2004,36
    4. Pitt HA , Gomes AS , Lois JF. Does preoperative percutaneous biliary drainage reduce operative risk or increase hospital cost?Ann Surg, 1985; 201: 546
    5.李兆申.胆道梗阻内镜治疗.许国铭,李兆申主编.上消化道内镜学.上海:上海科学技术出版社,2003,615~620
    6.秦明放.内镜腹腔镜联合治疗的新思维.中华消化内镜杂志,2003:20(5):293
    7.李宁,秦明放,王庆.外科手术与内镜鼻胆管引流联合治疗复杂性胆管结石.中国微创外科杂志,2001,6(8):64
    8.卢延,张雪哲主编.胰胆CT与MRI.北京:人民卫生出版社,
    
    2002,70~103
    9.李建设、王宇.胰腺癌致梗阻性黄疸姑息性手术方式的选择.中国实用外科杂志,1996,16(1):55
    10.王光霞.B型超声波技术在腹部外科中的应用.吴成中主编.腹部外科实践.第三版.天津:天津科学技术出版社,2004,110
    11. Diehl Sl, Lehmann KJ, Sadick M, et al. Pancreatic cancer: value of dual-phase helical CT in assessing respectability. Radiology, 1998, 206:373~378
    12. O' Malley ME , Boland GWL, Wood BJ , et al. Adenocarcinoma of the head of the pancreas:determination of surgery unresectability with thin-section pancreatic-phase helical CT. AJR, 1999, 173:1513-1518
    13.田雨霖.胰头癌所致梗阻性黄疸的诊断与治疗.中国实用外科杂志,1996;16(1):10
    14. Pettersson H, Editor in chief .The encyclopaedia of medical imaging. Ⅳ, ISIS, Medicalmedia, The NICER Institute. Lund and London, 1999
    
    
    15.卢延,张雪哲主编.磁共振水成像.北京:科学出版社;2000,1-86
    16.孟宪民.梗阻性黄疸的诊断.中国实用外科杂志,1996;16(1):7
    17.黄志强、黎鳌、张肇祥主编.外科手术学.第二版.北京:人民卫生出版社,1996,1033
    18.戴辉,窦科峰,李开宗等.胰头癌早期诊断的研究(附168例报告).中国实用外科杂志,2000;20(8):482
    19.赵玉沛,张太平.胰腺癌早期诊断若干问题探讨.威海:第三届全国肝胆胰脾外科新技术、新理论年会专题报告暨论文摘要汇编,1998:37
    20.崔乃强,吴成中.胰腺疾病.吴成中主编.腹部外科实践.第三版.天津:天津科学技术出版社,2004,1275
    21.李海民,窦科峰,周京师等.胰头癌内引流术式选择与术后生活质量比较分析.中华肝胆外科杂志,2003,9(3期):154
    22. Tsiotos GG, Farnell MB, Sarr MG. Are the results of pancreatectomy for pancreatic cancer improving? World J Surg, 1999, 23:913-919
    
    
    23. CuschieriA. HauerG. BerciG. et al. Laparoscopic choledochoduodenostomy [J]. Surg Laparosc Endosc, 1996, 6(5):318
    24. J. Kuriansky, A. aenz, E. Astudilo. et al. Simulaneous .laparoscopic biliary and retrocolic gastric bypass in patients with unresectable carcinoma of the pancreas [J].Surg Endosc, 2000, 14:179-181
    25.巴明臣,张红卫,陈积圣.腹腔镜在胰腺外科中的应用,中华普通外科杂志,2001;16(11):701
    26. Targarona EM, Pera M, Martinez J,et al. Laparoscopic treatment of pancreatic disorders: diagnosis and staging, palliation of cancer and treatment of pancreatic pseudocysts. [J] .Int Surg, 1996, 81(1):1
    27. Dc Rooij PD, Rogatko A, Brennan MF Evaluation of palliative surgical procedures in unresectable pancreatic cancer [J]. Br J Surg, 1991, 78:1053
    28. Shimi S, Banting S, Cuschieri A. Laparoscopy in the
    
    management of pancreatic cancer: endoscopic cholecystojejunostomy for advanced disease. [J] Br J Surg, 1992, 79(4):317
    29.冯泽荣.手助腹腔镜下超声刀脾切除加门奇静脉断流术.中国实用外科杂志,2002,22(7):436
    30. Gagner M, Pomp A, Herrera MF. Early experience with laparoscopic resections of islet cell tumor. Surgery, 1996,120:1051-1054
    31.田在善,李东华,沈长虹等.大承气汤治疗痞满燥实证机理的实验研究.中国中药杂志,1993,18(3):170
    32.吴成中.通里攻下法对急腹症所致多器官衰竭治疗作用.国家中医药管理局重点课题论文集.1997.
    33.宋继昌,宋建章.胆红素代谢与黄疸.吴成中主编.腹部外科实践.第三版.天津:天津科学技术出版社,2004,41