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胰臟癌 PowerPoint PPT Presentation


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胰臟癌. 一 . 前言 胰臟癌是現有人類罹患的惡性腫瘤當中,最嚴重、最具侵襲性且預後不佳的一種。直至末期才有較顯著的臨床症狀及此種癌細胞快速生長的特性,意味著大多數的病人當發病時,只能接受緩和治療。但唯有手術切除腫瘤,才能提供這些病人較好的長期存活機會。雖然降低手術後相關的死亡率,可以使病患五年存活率有顯著的提升,然而發病診斷時的病期和外科醫師是否能安全根除地切除腫瘤,才是決定病人預後最重要的因子與關鍵。. 胰臟癌. 二 . 發病率與死亡率 1. 最近 5-60 年來,胰臟癌的發病率在許多國家呈現穩定增加的情況。

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胰臟癌

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  • .

  • 1. 5-60

  • 2.

  • 3. 10%14%12%20%

  • 4. 80%60-8045

  • 5.

  • 6. ( = 1.4:1)


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  • .

  • (periampullary malignancy) Peutz-JegherK-ras


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  • .

  • 90%80%()265-85%35-45% 60% 40%


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  • .

  • 1. :

  • 2. :

  • 3.

  • ()

  • 5%5%

  • (Courvoisers sign)(Virchows node)()


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  • .

  • ()

  • 1. (Abdominal ultrasonography)

  • 80-95%()

  • 2. (Computer Tomography, CT)

  • 90%


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  • 2

  • 3D

  • 3. (Endoscopic retrograde cholangio-

  • Pancreatography, ERCP)

  • ERCPMRCPERCPERCP:


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  • 4. (Endosonography, EUS)

  • EUS

  • 5. (Angiography)

  • 60%

  • 6. (Laparoscopy)

  • ()35%


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  • .

  • :

  • 1. :

  • 2. :

  • 3. :

  • 4.

  • 5. :


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  • .

  • 5%20%(pancreatico- duodenectomy, Whipple procedure)10% : 14%12%antrumPPPD


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  • Whipple Whipple procedure PPPDWhipple procedure


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  • .

  • (PTCD)(bile leakage)ERCP

  • (biofilm)(bile sludge)10mm460%


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  • . (palliation)

  • (cachexia)()


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  • .

  • Gemcitabine, 1000mg/m2Gemcitabine6

  • (Radiotherapy)

  • 50cGy()


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  • (Chemotherapy)

  • 5-fluorouracil(5-FU)GemcitabineGemcitabine18%20-30%

  • (Combined chemotherapy and radiotherapy)

  • (Gastrointestinal Tumour Study Group)5-FU


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  • 20%GemcitabineOxaliplatin181530Gemcitabine 400mg/m260Oxaliplatin 30mg/m2 4500 cGy255601000 mg/m2Gemcitabine8(PR+ SD)4/5 (80%)


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  • GOFT

  • (6International Hepatopancreatobiliary Association)

  • (Purpose)

  • Gemcitabine/OxaliplatinOxaliplatin/5-FUGemcitabine/5-FUOxaliplatin/5-FUThalidomine

  • (Objectives)

  • Gemcitabine/Oxaliplatin/5-FU/ Thalidomide(GOFT) /(MTD)(DLT)

  • (Methods)

  • 1Gemcitabine2Oxaliplatin245-FUThalidomine(DLT)NCI-CTC (MTD)GOFT(level 1)Gemcitabine 1000 mg/m2 + Oxaliplatin 60 mg/ m2 + Thalidomide 100 mg(level 2)Gemcitabine 1000 mg/m2 + Oxaliplatin 70 mg/ m2 + 5-FU 1000 mg/m2 + Thalidomide 100 mg(level 3)Gemcitabine 1250 mg/m2 + Oxaliplatin 60 mg/ m2 + 5-FU 1000 mg/m2 + Thalidomide 100 mg


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  • (Results)

  • 1513 6612267508067523718GOFT1CR3PR(1pancreaticoduodenectomy)1SD4PR(3relaparotomy)1SD42161(Gr. 3/4)(DLT)621(Gr. 1/2)(7)(5)(5)(2)(2)(2)(1)> 5% (312%12%5.5%)> 5 % (16%)


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  • (Conclusion)

    (level 2) GOFT

  • .

  • 1. (Percutaneous celiac nerve block)

  • 2. (Radiation)

  • 3. (Narcotic medications)

  • (patches and sentinel patches)

  • 4.


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  • .


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