Cancer of the pancreas (courage surgical department) disease outline and treatment
April 7th, 2008 Guage
The cancer of the pancreas malignant degree is high, not the easy early time to discover, the shift early and quick, the prognosis is bad. Recent year cancer of the pancreas’s disease incidence rate in the home, outside has the markup. Because according to our country Beijing Xiehe Hospital as well as Hunan medical school affiliated hospital statistics, in the recent several years cancer of the pancreas in-patient compared to the beforehand 10 years high 3~4 times. Increased 3 times at the American cancer of the pancreas’s disease incidence rate, accounts for the tumor mortality rate 4th, is only inferior to the lung cancer, the colon cancer, breast cancer, is similar with the prostate gland cancer. Increases 4 times in Japan. Britain, Germany increased 2 times. in 1986 the US diagnosed for cancer of the pancreas’s new case reaches as high as 25550 examples, died in should sickness be 24000 examples. The cancer of the pancreas sees by the male, good sends above 40 years old, as accounts for 70~80% high take the caput pancreatis formation rate, may for the multi-centers also be possible for the pancreas in the direct proliferation. This sickness is in the digestive tract tumor with difficulty the early diagnosis tumor, the clinical discovery progress time cancer of the pancreas only has 10~30% to be possible to permanently cure, after permanent control the survival rate was still very low, 5 year survival rate is 0.18~5%. If take caput pancreatis cancer theory, its 3, 5 years survival rate as digestive tract cancer in low. In order to raise cancer of the pancreas’s survival rate, the key is enhances early the clinical detection rate.
[diagnosis]
Along with the medical department technology’s development, uses in cancer of the pancreas’s examination method increasing day by day, for cancer of the pancreas’s early time discovered that has provided the basis. When the cancer of the pancreas starts the symptom to be fuzzy majority, goes see a doctor has lost the surgery time, and the prognosis is very bad. Therefore, has the condition local custom make regular physical examination, like phantom the study and so on ultrasound inspection, CT, MRI, ERCP, SAG applications, the pancreatic juice cytology examination, the pancreatic gland puncture organization cytology inspection, the cancer related antigen determination as well as the ras gene inspection and so on, causes cancer of the pancreas’s early detection rate is the enhancement greatly.
[remedial measure]
First, cancer of the pancreas surgery’s treatment present situation
The shape cancer of the pancreas’s treatment still had a series of problems until now. Therefore also with difficulty uses some therapeutic schedule to its treatment to unify. The influencing factor are many to the treatment: Cancer of the pancreas’s biology characteristic and the ampule cancer is different, the shift early, some part of cases are also multi-centered, some cases are encircle the choledoch lower segment the bustle pipe infiltration growth; Cancer of the pancreas’s spot, the size, the malignant degree and so on affect its surgery’s effect, like Laurent(1993) report cancer of the pancreas permanently cures case its curative effect many factor restrictions (Table 1); The surgery way discusses anxiously in a big way, adopts the radical cure Whipple surgery? Or entire pancreas excision? Or the expanded caput pancreatis cancer excises has not unified completely. The radical cure Whipple surgery cleans up the scope to be insufficient, but must expand, but the entire pancreas excises its excision rate, the surgery mortality rate as well as 3, 5 years survival rate has not seen surpasses Whipple obviously, moreover after technique, the exocrine will rely lifelong on exogenetic, expansivity Whipple may retain the partial pancreas tail internal secretion to be possible to maintain, but around the pancreas cancer is invaded the blood vessel must excise, not only the surgery wound is big, 1, 3 years cure rate must the large amount case evidence; Depth jaundice, before the technique, whether can pass through the PTCD drainage reduced pressure, also completely has not obtained the consistent view. The above several questions in have been being puzzled surgeon, sometimes with difficulty determines the therapeutic schedule.
Table 1 radical cure pancreatic gland excises latter 1 year, 5 year survival rate and the influence factor
Factor 1 year (%) 5 years (%) around spot pancreas 58.5 10.4 ampules 78.6 52.4 tumor graduation ⅠOrⅡ 75.0 53.6 ⅢOrⅣ 63.6 18.5 bilirubin <2 85.7 71.4 >2 62.4 18.0 differentiation degrees good 90.0 in 20.2 either not good 50.0 0.0 size <4cm 67.7 23.7 >4cm 61.4 40.9 duodena are invaded are 71.6 59.7 otherwise 64.0 15.5 lymph node masculine genders 53.2 44.4 or many 78.6 26.6 radiotherapies have not been 72.9 0.0 otherwise 68.3 35.7 two, cancer of the pancreas’s surgery treatments
(1) cancer of the pancreas is consumptive extremely serious disease
Is really big to the physiological harassment. Cancer of the pancreas’s main pathology physiology change is: Jaundice and result hemoglutination function barrier; The specific weight becomes emaciated and malnutrition result whole body a series of changes; Endocrine changes and so on hyperglycemia or hypoglycemia.
1. jaundice: Carries on the aggravation is a cancer of the pancreas’s prominent symptom. When gallbladder ductus pancreaticus blocking affects fats food the digestion, the absorption, sends, but vitamin deficiency as well as dependent Vitamin K some hemoglutination factor (zymoplasm original,Ⅶ,Ⅸ,ⅩThe factor) lacks. The long-term bile duct obstruction causes the liver function harm, may also cause other not to rely on Vitamin K the hemoglutination factor to lack (for exampleⅤThe factor), and easy to have the fibrinolysis phenomenon, the cause surgery wild widespread oozing of blood. After injection Vitamin K, the zymoplasm time restores to when normal or accepts is normal, when again surgery, then the oozing of blood may reduce obviously. Serious blocking jaundice’s another serious question is after the surgery easy to present the acute kidney function not entire. When serious jaundice the acute kidney function not entire reason is various: If the kidney irrigation quantity and the renal glomerulus filtering coefficient are low; The jaundice increases the kidney susceptivity to the hypotension, the oxygen deficit and so on. High cholerythrin blood sickness itself then creates the renal glomerulus, the tubulus renalis serious damage. Therefore to diagnoses around the explicit deficiency special ampule the cancer, after passing through the technique reasonable corrects the whole body condition, should the early operation, after the technique, must watch out for the water, electrolyte balanced.
2. becomes emaciated: Becomes emaciated is cancer of the pancreas’s another prominent performance. Becomes emaciated because the reason often is the amount of radiation is insufficient, continues the ache, the digestion absorption function barrier and so on. The long time’s protein amount of radiation insufficiency, then causes in vivo the protein ingredient like muscle, the cardiac muscle, the enzyme, immune body protein consuming, after causing this kind of patient is easier to have the surgery, to infect, the margin to heal bad, the margin to split and so on complications. Along with organization’s consumption, the body weight drops rapidly, the whole body total blood volume also along with it reduction, the red blood cell capacity also drops. Regarding the body has a series of compatibilities to respond that like the whole body blood vessel bed contraction, adapts in reducing the blood volume, causes the blood pressure maintenance in certain level, but in this case carries on the anaesthesia, the surgery extra loses blood, loses the fluid, the circulation volume of blood sharp decline, then the blood pressure rapid drop even has the shock. Therefore, carries on the positive improvement patient’s nutrition condition before the technique, sharpens its immunity ability, after cutting the surgery mortality rate and surgery’s complication, is the great importance. If before the technique, the short-term gives the vein auxiliary nutrition or the essential food (about 2 weeks), may change patient’s whole body condition, the reverse negative nitrogen balance.
3. internal secretion’s change: The pancreatic disease patient possibly contracts the hyperglycemia or hypoxemia. Regarding the surgical operation patient, the blood sugar is excessively high lowly, is the danger. But around the surgery also frequently has causes the blood sugar Gao Huodi factor: Like the anaesthesia, the wound, the catecha phenol amine secretion increases, inputs infiltrates the glucose, fasting, the insulin application high excessive and so on. After usually in situation diabetic patient technique, maintain glucose in urine +~++ to suitably, like this then avoids the hyperglycemia or hypoglycemia’s danger.
Therefore, before the technique, should give the positive correction, enables it to achieve is being balanced. Like water, electrolyte, Vitamin K, C, hemoglutination factor, albumin supplement.
What the current argument are many are to depth jaundice’s processing: One kind is improves the symptom again surgery after the PTCD drainage, one kind cannot to do the PTCD drainage.
Nakayama when surpasses to the cholerythrin 171μmol/L, to 108 example patient PTCD(PTBC), the mortality rate by 28.3% drops to 8.2~6%. Braasch pointed out that when the cholerythrin is higher than 342μmol/L the mortality rate is 22%, is lower than this value mortality rate is 13%. Denning reported that the cholerythrin is lower than 102.6μmol/L, after not having the technique, the complication death, he also reports before the technique is PTCD, the surgery mortality rate by 25% drop to 16%, after the technique, the complication by 56% drops to 28%. Pitt and so on thought that the PTCD group and the control group mortality rate same (respectively are 8.1%, 5.3%), Pherson and so on (1984) reported that the PTCD group mortality rate is higher than the control group (32%, 19%). But the PTCD group hemorrhage, the infection complication are high, in hospital time is long.
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Entry Filed under: Pancreatic cancer
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