The pancreas cancer make a diagnosis and give treatment present condition and progress

Pancreas cancer(Pancreatic Carcinoma) the outbreak rate presents obvious up-trend within the scope of world in recent years, in the United States and Japan it the ill rate occupy all fourths of rates with ill tumors, in the meantime is our country population death of one of the ten greatest malignant tumors.The pancreas cancer lacked sensitive in early days with especially different diagnosis index sign, the cancer of the pancreas makes a diagnosis and give treatment in recent years the level have already shown a Zhao exaltation, the head hair symptom cures in time of the surgical operation excision rate can reach to 50%, but cure for good after the resection for 5 years and the existence rate is only 10%.Now make a diagnosis and give treatment pancreas cancer to present condition and make progress an overview as follows:

The present condition and progress of one diagnosis

1.1 tumors symbolize a thing

Have already reported that 20 remainings grow in the pancreas cancer marking thing cultural heritage, the main index sign includes CEA, CA50, CA19 － 9, POA, CA195, CA242, Span － 1, the Dupan － be 2 etc.s.Currently to the diagnosis of the tumor marking thing value the evaluation be the particularity isn't strong and exist false masculine gender, the pancreas cancer masculine gender rate is low in early days.Because the tumor has many antigens, apply many index sign consociation examinations can raise to confirm rate ［ 1, 2 ］s.

1.1.1 CA19 － 9:CA19 － 9 is currently to have one of the worth marking things most to the pancreas cancer diagnosis.Its serum is critical to be worth(cutoffvalue) for the 37 kus/L, low level(<200 kus/L=of surgical operation excision rate big, the tumor cut off behind CA19 － 9 obviously decline to normal prepare better behind.Lundin ［ 3 ］ report way CA19 － 9 can judge to prepare behind with monitor the tumor relapse.Kawa ［ 4 ］ report way CA19 － 9 diagnosis pancreas the sensitivity of the cancer is 82% and the particularity is 85%.Cerwenka ［ 2 ］s report its particularity is 68.4%, but if in the meantime the Yi egg white Mao depressant(PSTI) for normally be worth then CA19 －s 9 particularities can raise to 96%.

1.1.2 CA195s:The CA195 is lifted a kind of pure sugar antigen by the single anti- CC 3 C195s(IgM).The cultural heritage reports that a CA195 rightness of sensitivity of pancreases cancer is 64% to 100%.Andicoechea ［ 2 ］s report CA195 the serums are critical to be worth a 12 kus/L, sensitivity 89.5%, better than CEA.(53.7%)Particularity is 73.1%, if take the 100 kus/L as critical value, its particularity then is 97.1%.Hyoty etc. thinks the disease period of the CA195 level reflection pancreas cancer, swollen can cut off a manifestation to show Zhao differentiation in the cancer.

1.1.3 CA242s:The CA242 is a kind of new marking of the pancreas cancer thing.Kawa ［ 4 ］s report it diagnoses sensitivity and particularity of pancreas cancer to distinguish to 79% and 93% and have higher particularity.In the meantime CA242 level along with pancreas cancer of make progress but go up ［ 5 ］s.

1.2 cancer genes

The research of tumor molecular biology is a current tumor to learn to study of a little bit hot.There are various cancer genes with suppress cancer gene an expression in the pancreas cancer, such as ras, P53, c-erB 2, c-myc, P21 etc.ses.The gene research will bring vast foreground to the make a diagnosis and give treatment of pancreas cancer.

1.2.1 K-ras gene:Comprehensive cultural heritage expresses that the C-K-ras gene and pancreas cancer relate to most closely, cancerous with pancreas of occurrence, develop the process be germane.Kon-do ［ 6 ］s report the nipple form gland cancer K-ras inside the Yi tube 12 · be 011 · JHepatopancreatobiliarySurg1999s, Vol.11, No.2 password sub- mutation rates is 92%s, mutation form is GGTGAT, GTT or CGT.Kimura ［ 7 ］s report that 2 corpse check discover that the mirror descends the K-ras of the Yi tube gland cancer mutation, think the K-ras' mutation is a pancreas cancer the earlier period affairs of development.
1.2.the 2 P53 genes and P21 genes:The P53 suppresses cancer gene a swollen occurrence development with 50% near mankind's cancerses relevant, include a pancreas cancer.P53's male expression rate in the pancreas cancer in's ising 40% ～s is 50%s, Dergham ［ 9 ］ usage the immunity set turn a technique to take care of the gland cancer P53 and the P21 WAFs-1s an expression a research to 75 Yi, result the P21's masculine gender's expression present with in the pancreas cancer's existence just related, present with clinically in early days just related, the P53 expressed to have no with existence rate to show Zhao meaning, but the P53 male expression had relation with tumor later period.

1.3 images check

The image learned diagnosis to more and greatly make progress recently, such as through the Yi take care of mirror(Peroralpancreatoscope, Pops), super mirror inside the voice.(Endoscopicultrasonography, EUS)The Yi super voice(IDUS) inside the tube, the Ci resonance bile duct becomes to be like(MRCP).The positive electron projects spiral CT(HelicalorSpiralCT) etc. of the CAT scan(PET), dynamic state.

1.3.1 Pops:The Pops starts in the clinical application at the beginning of 90's.The type PF-80 that the Japanese Olympus company develop Pops, diameter 0.8 mms, become a burnt scope 1~50 mms, the picture is clear and be applicable to rules image to usually learn a technique hard definitely originate the disease of Dan Yi that the main Yi take care of.Japanese Vehera etc. ［ 12 ］s report the adoption Pops combines the Yi liquid cytology check, discovered 11 home position cancers in 72 pancreas cancers.

1.3.2 EUSs:The EUS is to stretch forward a super voice to pack at inside mirror top, tightly stick stomach Houpi to probe into the pancreas each part after sending into a stomach and intestines way, can show according to the reporthelpful, and to check a Yi inside tube 0.6 mms above pathological changes better than EUS.1.3.4 MRCPs:MRCP for don't encroach upon sex, have no complications and need not build a shadow a diagnosis method.Sufferer after can't make ERP,such as Dan bowel, to fit together Shu, or ERP failure and completely when the Geng Zu can't provide pathological changes scope, can choose application MRCP.

2 treatment present conditions and progress

Cure the only method of pancreas cancer still keep being to cure for good sex excision.The target of surgical operation is to raise a surgical operation excision rate, lower surgical operation complications and death rate and raise 5 year existence rate.Surgical operation complications most cultural heritages report surgical operation death rate about 5%, incidence rate about 25% ［s with 35% ～s be 11~13 ］s, the Italian Crucitti reports the surgical operation complications in 101 continuous cases 28.7%, the surgical operation death rate reach to 10.9% ［s be 14 ］s.After pancreas cancer cures for good to cut off, 5 year, the existence rate is only 10%, but small Yi cancer(<2 cms=5 years after the Shu, the existence rate can reach to 41%.Owing to pancreas cancer's diagnosing a difficulty in early days, surgical operation excision the rate was low, the German Bottger thought that the pancreas cancer doubt but confirmed malignant should go to cure for good sex excision ［ 15 ］s.The author implements 186, surgical operation complications and death rate to distinguish to 27 in a row.3% and 2.6%, the effect is good.

2.1 the concerning Shu type choose

The Shu type of pancreas cancer includes the pancreas parts of resections(Yi head the Yi of the cancer 12 bowels cut off whipple Shu, body tail cancer of Yi body tail cut off), whole Yi resection and extend to cure for good Shu.(namely local area pancreas cut off re-gionalpancreatectomg)The local area pancreas cuts off to put forward first from the Fortner, and cure 35, the surgical operation death rate is 23% and have no 5 years to survive.The Shu type choice still has a controversy currently, standard Shu type(whipple surgical operation) surgical operation death rate generally less than 2%.

Yi Lou(pancreaticfistula)'s ising a Yi is 12 empress serious complications of the bowel resection, incidence rate about 10% ［s 13, 14 ］s.If lead to flow the liquid starch Mao density(amy-laseconcentration, AMS)>the 1000 us/L can immediately diagnose the standard ［ of Yi Lou 17 ］s.Also have author report AMS>2000 us/L for diagnose Yi Lou of standard ［ 13, 15 ］s.The surgical operation basic request:(1)Fasten the film top vein left side to cut off a Yi neck in the bowel, find out a main Yi tube, while fitting together with jejunum prevention hurt or sew firm Yi tube.(2)Choice etc. diameter, many Huo gum tubes of side bore make a support.(3)The Yi bowel fit together, double the layer have no tension to sew up.(4)Pancreas carry side and jejunum on pancreas' back strach a muscle layer to sew up, is substantial the pancreas and it is together sewn up by the film.(5)Well lead to flow belly cavity.Bottger etc. ［ 13 ］s think that the pancreas quality is soft, the Yi tube doesn't increase thick, the Yi jejunum carry to fit together Yi Lou an incidence rate high.The author prevent°froms at the Yi Lou tall Wei sufferer sex usage kind have to settle to be subjected to good effect.Also there is author putting forward objection ［ 20 ］s.The prevention and cure of Yi Lou includes ① to keep on a valid Yi bed a double a set tube to lead to flow;The ② valid stomach and intestines decompression;The ③ vein high nourishment, or through stomach tube or place jejunum to place a tube through the Kuang Be fitted together to bring into jejunum Pan to go TEN by stomach and intestines;The ④ is effectively antibiotic;The ⑤ applies A cyanotype Mi Gua with 5-Fu;⑥ Once Yi Lou happenning keep a Yi liquid lucid to lead to flow of can use in the meantime kind have to settle 0.2 mgs, every 12 hours once, total 5~7 days.

2.4 pancreas cancer the dangerous factor of the surgical operation

Yi 12 complications and surgical operation death rate of the bowel resection be still high, therefore very important to dangerous factor valuation before the Shu.Crucitti ［ 14 ］s cut off the sufferer's review analysis to 101 pancreas cancers, the enunciation age, nourishment condition, don't characteristics and surgical operation method of the tumor biology influence after the Shu the complications and the death to remain  Ku a time a spring onion form a cover the Xie  Zhuo Xing Sou?Unit the following, in 90's after the complications incidence rate of surgical operation has been already descend.Age's ising not a Yi is 12 taboo certificates of bowel resections and in accordance with the Bottger standpoint the ［ be 13 ］s.The Bottger cuts off a case to carry on looking back sex analysis to 221 bowels with 12 Yis, think to lose the blood, Dan red and plain level, Yi tube diameter to relate to complications incidence rate in the Shu, the case of the Shu choice, clinical technique, processing experience, also relate to surgical operation effect.