胰头癌淋巴转移特点的探索和影响的因素

Features and influencing factors of lymph node metastasis of pancreatic head cancer

目的 探索胰头癌淋巴回流途径和淋巴结转移的特点 ,初步分析胰头癌淋巴结转移的相关因素 ,以指导胰腺癌根治术中的淋巴结清扫。方法 2 4例胰头癌标本应用手术显微镜法寻找淋巴结 ,并进行详细的分组。分析各组淋巴结的转移频率和相互关系。分析肿瘤大小、肿瘤组织学类型、术前血清肿瘤标志物与淋巴结转移的关系。结果 2 4例胰头癌平均每例找到淋巴结 37 7枚 ,证实 17例伴有淋巴结转移。第 13、14、12和 8组转移频率较高。 4例胰腺钩突肿瘤仅发生 14组淋巴结转移而不伴 13或 17组淋巴结转移。 4例 16组阳性的淋巴结均为 16b1亚组 ,主要分布于腹主动脉、下腔静脉、左肾静脉围成的三角形区域内。淋巴结转移与肿瘤大小、肿瘤组织学类型无关。伴有淋巴结转移的病人术前血清中CA50 、CA2 4 2 明显升高。结论 在胰头癌根治性切除时 ,即使是局限于胰腺内的小胰癌也应作广泛的淋巴结清扫。胰腺钩突肿瘤尤其要注意肠系膜上动静脉周围的淋巴结清扫。清扫腹主动脉周围淋巴结重点应在腹主动脉、下腔静脉和左肾静脉构成的三角形区域内。术前血清中CA50 、CA2 4 2 明显升高的病人术中更应注重淋巴结的清扫。

Objective To investigate the features of lymph node metastasis of pancreatic head cancer and explore its influencing factors. Methods Operative microscopy was applied in 24 cases after radical surgery of the pancreatic head cancer to find lymph nodes. Then the lymph nodes were grouped in detail and the metastatic frequency of each group was compared. The relationship between lymph node metastasis and other clinical or pathological factors were explored. Results The mean number of examined lymph node was 37.7/patient. Lymph node metastasis was found in 17 cases. The most common sites of lymph nodes involved were No. 13,No. 14,No. 12 and No. 8. Four pancreatic cancer derived from the uncinate process had superior mesenteric vessel lymph node metastasis but no post-pancreatoduodenal lymph node involvement. Most of the involved lymph nodes of paraaortic region were located in the triangular area surrounded by the abdominal aorta,inferior vena cava and left renal vein. There was no significant relationship between lymph node metastasis and the primary tumor size or histological type. Elevated preoperative serum levels of CA_ 50 and CA_ 24-2 were correlated to the lymph node metastasis. Conclusions In case of radical cancer resection,extensive lymph node dissection is necessary even if the tumor is localized within the pancreas. More attention should be paid to the lymph nodes around the superior mesenteric vessel,especially when the tumor is derived from the pancreatic uncinate process. It is important to clear the lymph nodes in the triangular area surrounded by the abdominal aorta,inferior vena cava and left renal vein. Elevated preoperative serum levels of CA_ 50 and CA_ 24-2 means that the pancreatic head cancer might have lymph node involvement.