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本文报道经手术及病理检查证实的壶腹癌、十二指肠乳头癌及胆总管下端癌87例。特殊检查中 ERCP 确诊符合率为94%,B 超及 CT 分别仅为30%及25%。87例中行次全胰十二指肠切除术63例,其中行改良式胰十二指肠切除术16例。根治术切除率为72.4%,壶腹癌、十二指肠乳头癌及胆总管下端癌切除率分别为88.6%,85.7%及27%。作者认为:ERCP 是早期发现和确诊本处癌肿的有效手段。术前积极准备、围手术期的监护并注意胰一空肠吻合技术、术后良好监护,对并发症早期发现和积极治疗及静脉营养支持,可有效地预防胰瘘的发生及降低术后死亡率。
This article reports 87 cases of ampullary carcinoma, duodenal papillary carcinoma, and common bile duct carcinoma confirmed by surgery and pathology. The rate of diagnosis of ERCP in special examinations was 94%, and B ultrasound and CT were only 30% and 25%, respectively. Of the 87 patients undergoing pancreatoduodenectomy, 63 underwent modified pancreaticoduodenectomy. The resection rate was 72.4%. The resection rates of ampullary carcinoma, duodenal papillary carcinoma, and common bile duct cancer were 88.6%, 85.7%, and 27%, respectively. The author believes that: ERCP is an effective means of early detection and diagnosis of cancer in this area. Preoperative preparation, perioperative care, attention to pancreatic-jejunal anastomosis, good postoperative care, early detection of complications, active treatment, and intravenous nutrition support can effectively prevent the occurrence of pancreatic fistula and reduce postoperative mortality. .