Diagnosis And Surgical Treatment Of 116 Patients With Pancreatic Head Carcinoma

Background:The pancreatic head carcinoma is a highly malignant tumor among all gastrointestinal tumors,its morbidity is increasing year by year in the world,that posing great threat to people's health.However,because of the special anatomical position and biological characteristics,that makes the pancreatic head carcinoma early diagnosis very difficult,the resection rates lower,easy to relapsing,more invasiving and having high mortality.At present,the surgical treatment is still the main mean of long-term survival for pancreatic head carcinoma,and with the improvement of surgical skills,the resectional rates has improved,while the long-term survival in patients with pancreatic head carcinoma is still unsatisfying.Objective:To analyze the clinical characteristics of the patients with pancreatic head carcinoma,choose reasonable examinations to elevate early diagnosis and comprehensive assessment for surgical treatment,raise the resectional rates of pancreatic head carcinoma.Methods: By retrospective study of 116 cases of pancreatic head carcinoma from January 2003 to December 2008 in our hospital,analyze the clinical data,use the software of SPSS13.0 for statistics,and review the relevant articles through CNKI and PubMed.Results:1.Among the 116 cases of pancreatic head carcinoma,men 73 cases,women 43 cases,so the male to female ratio was 1.70 times,and the age was from 33 to 86 years old,median age was 61 years old.The main symptoms were jaundice(62 cases 53.4%) and upper abdominal pain(49 cases 42.2%),weight loss(42 case 36.2%), upper abdominal discomfort (35 cases 24.2%),and so on. Jaundice(62 cases 53.4%),upper abdominal tenderness (26 cases 31.0%) and abdominal mass(13 cases 11.2%) were the main signs of pancreatic head carcinoma.2.The positive rate of CA19-9 for diagnosing was at 68.0 percent,while the CEA and AFP positive rates were 26.1% and 9.4%,CA19-9 was higher diagnostic sensitivity than that of CEA and AFP(P<0.05).There was no significant difference between CEA and AFP (P>0.05).3.Enhanced CT for the diagnosis of pancreatic head carcinoma was up to the rate of 100%,compared with ultrasound and CT scan (P>0.05),the difference was not statistically significant,while contrasted enhanced CT compared with other Imaging examinations(P<0.05),there was statistically significance.4.The results of tumor stage,â… stage,â…¡stage,â…¢stage,â…£stage were 10 cases(7.8%),46 cases(39.7%),44 cases(37.9%) and 17 cases(14.7%),more than 90% patients were meta-advanced stage when they saw doctor.The operability was 81.0%(94/116),and the radical resectability rate was 28.7%(27/94).5.The median survival time of radical resection group was 13.0 months,non-resection group 6.1 months,and the non-surgical treatment group 5.3 months.Survival time of resection group was significantly higher than that of non-resection group(P<0.01),there was not significant difference between non-resection group and non-surgical treatment group in survival time(P>0.05).Conclusion:1.There are no specific early symptoms or sign of pancreatic head carcinoma,we should be vigilant of the high-risk patients and give them regular medical checkups in order to improve the early diagnosis of the tumor.2.Tumor marker CA19-9 and ultrasound can be used as the preferred screening methods for pancreatic head carcinoma,contrast enhancement CT is one of the most important examination for diagnosis and evaluation of resectionability of pancreatic head carcinoma.3.It is critical to chose right surgical treatment according to the specific situation of patients to advance the life quality and extend long term survival.