全球范围内,胰腺癌的发病率和罹患率逐年升高,中国也不例外.胰腺癌常见危险因素包括糖尿病、慢性胰腺炎、吸烟、胰腺癌家族史和酗酒等.胰腺癌缺乏特异的临床表现和敏感的早期诊断指标,其诊断和随访常用的血清标志物是CA19-9.目前胰腺癌术前的诊断和分期主要依赖于影像学表现,螺旋CT增强扫描是最常用的影像手段.超声造影、超声内镜、PET/CT等新出现的影像诊断方法进一步提高了诊断的敏感性和特异性.对胰腺癌可切除的患者,不推荐常规作术前穿刺活检;但对拟直接作放化疗的患者,建议穿刺活检取得病理.术前腹腔镜检查可检出腹膜播散的患者,应避免不必要的手术.对Ⅰ、Ⅱ期的胰腺癌患者,应争取达到R_0切除,以提高生存率.%The incidence and prevalence of pancreatic cancer have been steadily increasing globally and domestically. The common risk factors of pancreatic cancer include diabetes mellitus, chronic panereatitis, cigarette smoking, family history of pancreatic cancer, and alcoholism. There is no specific symptom and early diagnostic marker of pancreatic cancer. CA19-9 is the most commonly used serum marker for the detection and follow-up of pancreatic cancer. However, its sensitivity and specificity precluded its use in screening of the disease. Enhanced spiral CT scan is the routine radiological modality for the diagnosis and staging of pancreatic cancer. Newly developed diagnostic modality such as ultrasound contrast imaging, endoscopic ultrasound, PET/CT scan further improved the sensitivity and specificity of diagnosis. Preoperative fine needle aspiration (FNA) is not recommended for patients with resectable pancreatic cancer. Pathological confirmation by FNA is necessary for patients who will be treated by chemotherapy or chemoradiotherapy. Preoperative staging laparoscopy can rule out the patients with abdominal seeding, so that unnecessary open surgery is avoided. In order to achieve better survival, every effort should be made to achieve R_0 resection for patients with stage Ⅰ or Ⅱ disease.
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