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首页> 外文期刊>Surgical Endoscopy >Concomitant laparoscopic gastric and biliary bypass and bilateral thoracoscopic splanchnotomy: the full package of minimally invasive palliation for pancreatic cancer.
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Concomitant laparoscopic gastric and biliary bypass and bilateral thoracoscopic splanchnotomy: the full package of minimally invasive palliation for pancreatic cancer.

机译：伴随腹腔镜胃，胆道搭桥术和双侧胸腔镜内脏切开术：胰腺癌微创缓解的完整包装。

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INTRODUCTION: Pancreatic cancer is unresectable in 80% or more of patients. Biliary and duodenal obstruction and intractable abdominal and back pain are the most common complications of the disease. These complications may be palliated effectively using minimally invasive techniques. Their combined application in a single setting is presented and discussed in this article. CASE REPORT: A 59-year-old man with a locally advanced carcinoma of the head of the pancreas presented with obstructive jaundice and intractable pain requiring opiate analgesia. An attempt at endoscopic biliary stenting was unsuccessful, and a percutaneous biopsy was deemed unsafe. Preoperative magnetic resonance cholangiography showed cystic duct insertion abutting the upper limit of the biliary stricture. A laparoscopic Roux-en-Y hepaticojejunostomy, prophylactic loop gastroenterostomy, and tumor biopsy were combined with a bilateral thoracoscopic splanchnotomy. RESULT: Surgery and subsequent recovery were uneventful, and the patient was discharged from hospital on the fourth postoperative day off opiates. He remained free of jaundice and severe pain, until 6 months later, when he represented with jaundice, cachexia, and proximal small bowel obstruction secondary to multiple liver and peritoneal metastases. He underwent further palliative laparoscopic enteric bypass with resolution of the intestinal obstruction, but died of the disease 10 days later. CONCLUSION: Laparoscopic gastric and biliary bypass and bilateral thoracoscopic splanchnotomy may be safely combined to provide an effective comprehensive minimally invasive palliation of incurable pancreatic cancer.
机译：简介：胰腺癌在80％或更多的患者中无法切除。胆道和十二指肠梗阻以及顽固的腹部和背部疼痛是该病最常见的并发症。使用微创技术可以有效缓解这些并发症。本文介绍并讨论了它们在单个环境中的组合应用。病例报告：一名59岁的男子，患有胰腺头部局部晚期癌，表现为阻塞性黄疸和顽固性疼痛，需要鸦片镇痛。内镜胆道支架置入术的尝试未成功，经皮穿刺活检被认为是不安全的。术前磁共振胆管造影显示胆囊管插入紧靠胆管狭窄的上限。腹腔镜Roux-en-Y肝空肠吻合术，预防性肠胃造瘘术和肿瘤活检与双侧胸腔镜内脏切开术相结合。结果：手术和随后的康复情况良好，患者在术后第四天从鸦片中脱离出院。他一直没有黄疸和剧烈疼痛，直到6个月后才出现黄疸，恶病质和因多发肝和腹膜转移而引起的近端小肠梗阻。他接受了姑息性腹腔镜肠旁路手术，肠梗阻得以缓解，但在10天后死于该病。结论：腹腔镜胃和胆道搭桥术和双侧胸腔镜内脏切开术可以安全地结合使用，以提供一种有效的，综合性的微创缓解性治愈胰腺癌的方法。

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