近40年中,胰腺癌的发生率呈3倍比增加,且其中85%为壶腹周围癌。在美国,每年将发现28000多例新病人,而且确立诊断时,许多肿瘤已不能切除。对此,以解除胆道梗阻为主的姑息性治疗已成为主要目的。近年来,壶腹周围癌的胰十二指肠切除术死亡率已显著降低,但对不能切除的病变,姑息性治疗的现状以及手术死亡率和并发症如何,目前尚未澄清。为此,作者就这些问题,对Johns Hopkins医院54个月118例病人进行前瞻性研究。作者认为,对于不能切除的壶腹周围癌,历来进行手术姑息性治疗,近年来却遇到了非手术减压引流方法的挑战。某些对比研究报告指出:对这类梗阻性黄疸的处理,经内镜或穿刺途径放置支撑管,在一定时间内,可达到与手术转流同样的效果。而且,并发症、病死率较低,住院时间较短。但对比的病例较少,重症缓解可维持多久也值得考虑。同时,伴有十二指肠梗阻等病人,非手术介入法也不可能给予解决。因此,它的应用价值尚待进一步研究。 In the past 40 years, the incidence of pancreatic cancer has increased by a factor of 3, and 85% of them are periampullary cancers. In the United States, more than 28,000 new patients will be found each year, and when the diagnosis is established, many tumors cannot be removed. In this regard, palliative treatment based on relieving biliary obstruction has become the main goal. In recent years, pancreatoduodenectomy mortality has been significantly reduced in periampullary cancers, but the status of palliative care, surgical mortality, and complications for unresectable lesions have not been clarified. To this end, the authors conducted a prospective study of 118 patients at Johns Hopkins Hospital for 54 months on these issues. The authors believe that surgical palliative care has been performed for unresectable periampullary cancer, but recent years have encountered the challenge of non-surgical decompression and drainage methods. Some comparative studies have pointed out that for the treatment of obstructive jaundice, stents placed by endoscopy or puncture approach can achieve the same effect as surgery bypass in a certain period of time. Moreover, complications, mortality, and hospital stay are short. However, the number of comparisons is relatively small. It is also worth considering how long a severe remission can last. At the same time, patients with duodenal obstruction and other patients, non-surgical intervention can not be resolved. Therefore, its application value needs further study.