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目的 探讨胰头癌姑息性手术的术式选择。方法 对近 2 0年来 187例姑息性手术治疗的胰头癌患者临床资料进行回顾性分析。结果 手术死亡率 8 6 % ;肝 (胆 )总管空肠吻合术 (HDJS)手术死亡率并不高于胆囊空肠吻合术 (CJS) (P >0 .0 5 ) ,HDJS术后复发性黄疸和胆管炎发生率显著低于CJS(P <0 .0 2 5 ) ,术后生存期显著长于CJS(P <0 .0 1) ;胆肠吻合加胃空肠吻合术 (GJS)手术死亡率并不显著高于单纯胆肠吻合术 (P >0 .0 5 ) ,术后生存期却显著长于胆肠吻合术 (P <0 .0 1)。单纯胆肠吻合术十二指肠梗阻发生率为2 9 3%。结论 胰头癌姑息性手术术式应尽量选择Roux en Y式HDJS ,同时作预防性胃空肠吻合术。
Objective To explore the choice of surgical operation for palliative pancreatic cancer. Methods The clinical data of 187 patients undergoing palliative surgery for pancreatic head cancer in the past 20 years were retrospectively analyzed. Results The operative mortality rate was 86%. The operative mortality of hepatobiliary jejunostomy (HDJS) was not higher than that of gallbladder jejunojejunostomy (CJS) (P > 0.05). Recurrent jaundice and bile ducts after HDJS were performed. The incidence of inflammation was significantly lower than that of CJS (P <0. 0 2 5). The postoperative survival was significantly longer than that of CJS (P <0.01). The surgical mortality of biliary-enteric anastomosis plus gastrojejunostomy (GJS) was not significant. Higher than biliary-enteric anastomosis (P > 0.05), the postoperative survival was significantly longer than that of cholangiojejunostomy (P < 0.01). The incidence of duodenal obstruction in biliary-enteric anastomosis was 293%. Conclusion The pancreatic head cancer palliative operation should try Roux en Y type HDJS as much as possible, at the same time for prophylactic gastrojejunostomy.