Pancreatic cancer is characterized by its insidious onset, which is easy to be present with liver metastasis or other distant organ metastasis at advanced stage, so the prognosis is extremely poor with 5-year survival rate being 4%-6%. Radical resection may be the only curative treatment. How?ever, most patients have lost the chance for surgical resection because of late diagnosis, and the resection rate is less than 20%. What??s more, postoperative complications and recurrence make influence on pa?tients?? quality of life without significant improvement. For now gemcitabine acting as the gold standard chemotherapy for the treatment of pancreatic cancer, approved by FDA as the first-line chemotherapy drug, can significantly prolong patients??lifetime. Gemcitabine combined with other drugs not only increase the anti-tumor effect, but also decrease the frequency of adverse events and drug resistance. Combination therapy such as gemcitabine+nab-paclitaxel, gemcitabine+erlotinib, gemcitabine+capecitabine have be recommended as the first-line therapy for the treatment of pancreatic cancer by the latest NCCN Guide?lines. This article reviews the most current articles, looking for developments about the gemcitabine-based first-line therapies in order to find better treatment and research strategy of pancreatic cancer.

目的 探讨不同浓度染料木素对胰腺癌细胞作用及其抑癌基因表达的研究.方法 本实验共分实验组(80,120,160,200 μmol/L)的染料木素、空白对照组(PBS)和标准对照(吉西他滨).各组培养基处理细胞12,24,36,48,60 h后,细胞计数试剂盒(CCK-8)法检测人胰腺癌细胞株PANC-1在染料木素作用下的增殖活性;流式细胞术检测人胰腺癌细胞株PANC-1在染料木素木素作用下的凋亡细胞百分率;用逆转录-聚合酶连反应(RT-PCR)方法测定P53及P21抑癌基因的表达;Western-blot法检测抑癌基因P53和P21的蛋白表达水平.细胞凋亡与细胞基因mRNA采用的是LSD法,细胞增殖数据采用的是配对f检验.结果 流式细胞术显示,人胰腺癌细胞株PANC-1处理后60 h时在不同浓度(80,120,160,200 μmol/L)的染料木素作用下细胞凋亡率分别为(3.72±1.58)％、(35.98±3.76)％、(51.36±4.32)％和(64.10±2.09)％.吉西他滨(gemcitabine,GEM)组为(43.45±5.28)％,不同浓度染料木素组与标准对照组间比较差异有统计学意义(均P＜0.01);细胞增殖效果:160 μmol/L与200 mol/L、120 μmol/L与200 μmol/L、200 μmol/L与吉西他滨组之间比较,均有统计学意义(P＜0.01),而160 μmol/L与吉西他滨组比较无统计学意义(P＞ 0.05);Western-blot检测蛋白水平显示160 μmol/L和200 μmol/L染料木素相对于空白对照能够明显的增强抑癌基因P21和P53的蛋白水平的表达,相对于标准组没有明显的差异.结论 染料木素可以抑制人胰腺癌细胞株PANC-1增殖,并且初步探索了这种抑制作用表现出浓度及时间依赖性.

目的 比较Whipple手术与腹腔镜技术在胰腺癌治疗中的优缺点,初步评价腹腔镜技术治疗胰腺癌的临床效果.方法 收集并分析2010年1月至2014年1月22例行胰腺癌手术治疗的患者,并对其进行全程随访.其中Whipple手术组14例,腹腔镜组8例,观察比较两组患者手术时间、失血量、住院时间、切缘阳性率、术后并发症发生率等.结果 腹腔镜组手术时间、术中出血量、术后住院时间均明显低于Whipple手术组,差异均有统计学意义(P均＜0.05);疼痛评估:术后24 h内,两组VAS评分差异无统计学意义(P＞0.05),但术后48、72 h,腹腔镜组VAS评分明显低于Whipple手术组,差异均有统计学意义(P均＜0.05).腹腔镜组术后并发症发生率(12.5％)明显低于Whipple手术组(42.9％),差异有统计学意义(P＜0.05).术后病理组织学检查两组切缘阳性率均为0.两组均无手术死亡病例.结论 腹腔镜在治疗胰腺癌,尤其是胰体、尾部肿瘤时,比Whipple手术具有优势.