胰腺癌晚期有哪些保守治疗手术？
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">胰腺癌是一种恶性化程度较高而治疗效果较差的腹部肿瘤，其特点是易<span style="color: black;">出现</span>远处转移，对放化疗不<span style="color: black;">敏锐</span>，一旦腹膜、肝脏和横结肠等任一部位受到侵犯，都<span style="color: black;">不可</span>进行胰十二指肠切除术。<span style="color: black;">因此呢</span>，姑息治疗<span style="color: black;">成为了</span>许多胰腺癌晚期<span style="color: black;">病人</span>的首选。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(1)外科姑息手术的指征：<span style="color: black;">针对</span>胰腺癌姑息治疗是<span style="color: black;">要紧</span>的。<span style="color: black;">由于</span>大约88%的病人<span style="color: black;">因为</span>肿瘤局部扩散和转移而<span style="color: black;">不可</span>实施根治性手术，当原发肿瘤<span style="color: black;">不可</span>切除时，外科医师<span style="color: black;">必要</span>决定采取何种姑息性<span style="color: black;">办法</span>来减轻胆道或十二指肠的梗阻。<span style="color: black;">另外</span>，还<span style="color: black;">必须</span>内外科<span style="color: black;">协同</span>以处理黄疸、<span style="color: black;">病痛</span>、体重丢失、胰腺功能不足，<span style="color: black;">乃至</span>抑郁和衰竭等。还有<span style="color: black;">便是</span>内科放胆道支架或引流失败，或放入支架后重新梗阻<span style="color: black;">乃至</span><span style="color: black;">出现</span>胆管炎等<span style="color: black;">状况</span>，<span style="color: black;">也</span><span style="color: black;">必须</span>外科处理。<span style="color: black;">选取</span>姑息减黄手术，不仅在手术前要做出判断，<span style="color: black;">况且</span>在开腹后应<span style="color: black;">仔细</span>探查腹腔，探查的<span style="color: black;">办法</span>及<span style="color: black;">次序</span>同胰头十二指肠切除术。<span style="color: black;">一般</span>如肿瘤侵犯肠系膜根部或门静脉即认为不适合做根治性切除，而行姑息手术，必要时还需细针穿刺细胞学或活体组织<span style="color: black;">检测</span>证实后方能实行。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">(2)外科姑息手术的<span style="color: black;">办法</span>：<span style="color: black;">针对</span>不适合做根治性手术的病例，常常<span style="color: black;">必须</span>解除梗阻性黄疸，<span style="color: black;">通常</span>采用胆囊空肠吻合术，<span style="color: black;">没</span><span style="color: black;">前提</span>者可做外瘘(胆囊造瘘或胆管外引流)减黄手术，<span style="color: black;">都数</span>病人能够短期内减轻症状，改善周身状态，<span style="color: black;">通常</span><span style="color: black;">存活</span>时间约在半年<span style="color: black;">上下</span>。姑息减黄手术<span style="color: black;">重点</span>有以下几种：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">①胆囊空肠襻式吻合术：胆囊空肠襻式吻合术是将胆囊与空肠吻合后，为预防胆道上行感染，在Treitz韧带下方15cm常规行空肠两侧间侧侧吻合(Braun吻合)。此种胆囊空肠吻合术<span style="color: black;">拥有</span>容易显露、吻合方便、手术时间短、并发症少等优点，可<span style="color: black;">做为</span>首选术式。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">②胆囊空肠Roux-en-Y吻合术：胆囊与空肠Roux-en-Y吻合术是距Treitz韧带下方15cm切断空肠，将远端空肠经结肠前或结肠后拉到胆囊<span style="color: black;">周边</span>。空肠与胆囊间的吻合<span style="color: black;">办法</span>为将空肠断端缝合闭锁，行胆囊空肠端侧吻合，<span style="color: black;">也</span>可采用端端吻合。此法虽然操作稍<span style="color: black;">繁杂</span>，但术后<span style="color: black;">出现</span>上行胆道感染的机会较少。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">手术中如见胆囊不扩张时，说明胆汁<span style="color: black;">不可</span>进入胆囊，此时应<span style="color: black;">选取</span>空肠与肝总管或空肠与胆总管吻合术。如确实采取胆囊空肠吻合术时，应<span style="color: black;">同期</span>加胆囊管与肝总管或胆总管间的侧侧吻合，<span style="color: black;">保证</span>胆汁引流通畅。若合并胆道感染，胆囊炎症水肿严重，宜行胆囊造瘘术。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">③胆总管空肠吻合术：胆囊空肠吻合虽然简单，但疗效不及胆总管空肠吻合术。<span style="color: black;">通常</span>胆囊空肠吻合术后平均<span style="color: black;">存活</span>时间为4.7～6.7个月，复发黄疸与胆管炎为1.5%～64.0%，平均为20%;而胆管空肠吻合术后平均<span style="color: black;">存活</span>时间为5.7～9.2个月，复发黄疸与胆管炎为7.3%～16.6%，平均8%。<span style="color: black;">以上</span><span style="color: black;">状况</span><span style="color: black;">显示</span>，胆管空肠吻合较胆囊空肠吻合效果要好<span style="color: black;">有些</span>。胆管(胆总管或肝总管)与空肠吻合可采用Roux-en-Y形侧侧或端侧吻合，如胆管有扩张(<span style="color: black;">通常</span>大于2cm)则最好<span style="color: black;">选取</span>端侧吻合。应常规<span style="color: black;">安置</span>胆道引流，起到胆道及吻合部位的减压<span style="color: black;">功效</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">针对</span>胰腺癌<span style="color: black;">疾患</span>的姑息治疗方式所取得的成果<span style="color: black;">必要</span>要结合<span style="color: black;">病人</span>的<span style="color: black;">实质</span><span style="color: black;">状况</span>才行，<span style="color: black;">由于</span>这种<span style="color: black;">疾患</span>的死亡率是非常高的，<span style="color: black;">必须</span>充分的<span style="color: black;">把握</span>好<span style="color: black;">疾患</span>的<span style="color: black;">关联</span>特点<span style="color: black;">而后</span>运用现代临床当汇总的科技知识，从而能够更好的做好<span style="color: black;">疾患</span>的<span style="color: black;">掌控</span>。临床上，<span style="color: black;">亦</span><span style="color: black;">思虑</span>中西医结合，采用中药<span style="color: black;">护理</span>的手段，<span style="color: black;">尽可能</span>延长<span style="color: black;">病人</span>生产期。如提取自传统中药人参的人参皂甙Rh-2<span style="color: black;">能够</span><span style="color: black;">经过</span>使癌细胞逆转成正常细胞的分化<span style="color: black;">功效</span>、调控肿瘤细胞的增殖周期、免疫调节<span style="color: black;">功效</span>和修复肿瘤<span style="color: black;">病人</span>放化疗<span style="color: black;">导致</span>的<span style="color: black;">损害</span>四大机制来达到抗肿瘤功效。</p>
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