中文摘要：

近年来胰腺外科取得了长足的发展，胰腺手术的并发症、手术死亡率显著下降。但是胰腺癌患者的5年生存率并未有明显提高。胰腺癌外科治疗方面还存在许多困惑和争议。本文从胰腺癌治疗效果差这一临床现状开始讨论，试图从肿瘤生物学的角度给出可能的答案；并就胰腺癌手术中存在的一些技术层面问题，包括胰头肿块的鉴别诊断、胰头癌的术前减轻黄疸治疗、胰腺癌患者行R0／R1手术的价值、消化道重建和胰肠吻合技术与胰瘘、胰十二指肠切除术后胃排空障碍等进行了探讨。同时笔者介绍了临床工作中的一些体会和思考。

英文摘要：

Pancreatic surgery has achieved substantial improvement in recent years, which was indicated by the contin- uous decrease of its mortality and morbidity. However, the over- all 5-year survival rate of pancreatic cancer patients has not been significantly improved, and puzzles together with controversies remain in the field of surgical treatment for this devastating disease. Clinical outcomes of pancreatic cancer patients remain poor, which we thought would largely explained by the extremely malignant biological behavior of pancreatic cancer. In this review, we also focused on the frequently discussed themes in the field of surgical treatment for pancreatic cancer. These themes include differential diagnosis for pancreatic head mass, preoperative biliary drainage for jaundice patients, value of R0/R1 resection for pancreatic cancer, pancreatic fistula and delayed gastric emptying after pancreaticoduodenectomy.