The surgery of the pancreas with main cancer treats _'s treatment

The surgery of the pancreas with main cancer treats _'s treatment
Pancreas excise the intersection of skill and the intersection of radical cure and method, pancreas of cancer excise for operation, diagnose because of the intersection of pancreas and cancer difficult in early days, it is about 4-9 months to establish the time to diagnose that the patient firsts publish symptom, the excising rate of operation is under 24, so survival rate is under 10 in 5 of most reports. The pancreas excises the skill and is divided into:
1 . The pancreas duodenum excises the skill and suitable for pancreas head cancers and pot belly cancers. W hipple adopted the skill of this proficiency in 1935, had had a lot of improvements already, included the way to excise the range and rebuild (see Fig. 3 3-5) . The excision range that the pancreas duodenum excises the skill should generally include section under some stomaches, duodenum, pancreas head and person in over-all charge of gallbladder, the treatment method of the end yes that the pancreas is cut Cut the end of the pancreas to sew up and lock after the ligature of pancreatic duct; The pancreas is cut end and jejunum do the end identically; Pancreas cut end and jejunum act as end to be identical. Some still put the silent stock tube to make the support in the pancreatic duct. Rebuilding the operation includes the gallbladder ' Or person in over-all charge of gallbladder) Jejunum identical and pancreas cut end jejunum identical to coincide with jejunum of stomach. The proportion in view of the lymphocytic transformation is very high, what the pancreas duodenum is excised should add the regional lymph node to remove conventionally while, namely increase the alternative appropriately and remove the third stop lymph node on the basis of excising the first, 2 stations of operations.

2 . Keep stomach and the intersection of pancreas and duodenum of pylorus, excise T rav e r so create, use the intersection of P P P D and surgery this at first 1978 such as skill, its advantage is as follows, the stomach capacity is big, the stomach is returned to and flowed and is prevented partly, the nutritional status can see and improve; The time of operation is shortened, needn't walk the stomach to excise, duodenum jejunum is identical and relatively simple and convenient too. The medical university subsidiary Huashan hospital of Shanghai once implemented this operation to the case that pancreas head cancer was relatively limited, effectual in the near future, the time of retention of postoperative stomach is slightly long, the intestines and stomach reduce pressure the tube will be stood for 5-7 days.
3 . The whole pancreas excises the skill in recent years, many centres of pancreas cancer have illness coming on the theory causes people's attention more and more, pancreas head cancer besides lying in the main cancer cooking stove of the pancreas head, find the occuring frequently little cancer cooking stove in whole other positions that pancreas organize, this discovery has offered the important theoretical foundation for the fact that the whole pancreas excised the skill. Reported recently the morbidity of many centres of pancreas cancer was 1 9 - 2 4 % , And think the pancreas duodenum excises the postoperative incomplete pancreas and recurs cancer mostly relate to occuring frequently in the cooking stove of cancer in the incomplete pancreas. The whole pancreas excise skill, dispel the intersection of pancreas and duodenum excise postoperative pancreas, leak possibility of complication fundamentally, but diabetes and pancreas exocrinosity function do not cause and digest and assimilate sequela such as the obstacle completely, study the whole near long-term curative effect that pancreas excise, have advantage recently, should know card of meeting it strictly, still can't substitute the pancreas duodenum excision at present.
4 . The pancreas of limitation excises the skill and is used in early body of pancreas, tail cancer more.
In the pancreas excises the adaptation card of the skill and working techniques selected for use, the following problems are noteworthy:
( 1 ) The operation wound that the pancreas duodenum excises is very great, should consider carefully it and meet card and possibility. Can't observe but check and can make diagnosis by pathology only according to the naked eye. If the infiltration and shifting the focus of cancerous swelling has already gone beyond the range of radical operation, even excise by force, can't improve long-term survival rate either.
The pancreas incomplete end treatment method differs. The ligature of simple pancreatic duct is not done identically and putting and guiding, 5 0 - 1 0 0 % the patient leaks, the jejunum mucous membrane of pancreas leaks the incidence to the identical one pancreas of mucous membrane as 14, it is 13 to telescope the incomplete end of pancreas in jejunum. Each can select habitual skill type for use, but for fine in order to adopt simple the intersection of pancreatic duct and the intersection of ligature and skill.
Because the pancreas duodenum excises the postoperative identical incidence of mouthfuls of ulcer 6 - 5 0 % , Whether add and make nervus vagus and cut off the skill and still exist and dispute. C hrist wait for report add, make nervus vagus, cut off gastrointestinal the intersection of bleeding and incidence of skill for 12 recently, and the persons who do not make, as 9. G rac e wait for report, add, make or make nervus vagus, it cuts off gastrointestinal bleeding of skill to be 9 and 12 respectively in incidence, identical mouthfuls of ulcer incidence are 4 and 6 respectively.
( 2 ) There is one and finish two kinds by stages pancreas duodenum excises skill. Perform the operation and lengthen the course of treatment by stages, increase cancerous swelling and sow the scattered chance shifting again, perform the operation adhesion more again, operation relatively difficult, should strive the first stage of operation excise. But it is proper to belong to the following situations by performing the operation: Persons who fail to diagnose clearly of icy cut sections for microscopic examination in the skill; The patient's too serious persons who but can't tolerate the first stage of operation of condition; Jaundice combines the companion serious person who damages liver function more deeply before patient's skill.
( 3 ) Perform the operation by stages, mainly relieve obstructive jaundice first, in order to improve the patient's whole body situation, operate and try hard to be simple in first operation, for instance, the gallbladder makes Lou's skill. If the bile duct is expanded obviously, make P T C D first and after jaundice is lightened, and then do the excision in the liver.
( 4 ) Adopt which kind of the intersection of pancreas and duodenum of pattern excise skill, rebuild identical mouth in the skill arrange order should jejunum formerly identical with pancreas, coincide with jejunum of stomach for the intersection of bile duct and jejunum secondly, pancreas, the intersection of bile duct and the intersection of jejunum and identical mouth fit with jejunum of stomach the distance between the mouth should exceed 30 c m, can avoid the upgoing infection of the pancreas, bile duct.

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