不同TNM分期胰腺癌患者根治性切除术疗效分析

Effect of radical operation on patients with different TNM stage pancreatic carcinoma

目的 探讨根治性切除术治疗不同TNM分期胰腺癌患者的临床疗效.方法 回顾性分析中国人民解放军总医院（301医院）肝胆外科2009年1月-2013年12月行根治性切除术的318例胰腺癌患者的临床资料,将根治性切除术患者依据不同TNM分期分组后,进行生存分析情况的描述和组间比较.结果 随访终点为2014年9月,随访时间1 ～ 67个月,中位时间11个月,根治性切除术患者的总体随访率为88.4％ （279/318）,其半年、1年、2年生存率分别为82.6％、57.9％、31.1％,平均生存时间为（23.2±0.4）个月;其中Ⅰ期患者半年、1年、2年生存率分别为94.4％、68.2％、58.7％,平均生存时间为（40.3±2.4）个月;Ⅱ期患者半年、1年、2年的生存率分别为85.8％、61.2％、28.3％,平均生存时间为（21.9±0.4）个月;Ⅲ期患者半年、1年、2年的生存率分别为65.0％、41.9％、19.4％,平均生存时间为（15.9±1.2）个月;Ⅳ期患者半年、1年、2年的生存率分别为37.5％、12.5％、12.5％,平均生存时间为（8.5±3.2）个月.Log-Rank检验结果提示,Ⅰ、Ⅱ期患者生存率和平均生存时间均高于Ⅲ、Ⅳ期（P＜0.05）.结论 根治性切除术是胰腺癌患者获得长期存活的有效治疗手段,尤其是对于TNM分期较早的患者,而对于Ⅳ期胰腺癌患者,根治性切除术疗效不佳.

± Objective To investigate the clinical effect of radical operation in patients with different TNM stage pancreatic carinoma.Methods Clinical data about 318 pancreatic carinoma patients underwent radical operation in Chinese PLA General Hospital from January 2009 to December 2013 were retrospectively analyzed according to the inclusion criteria.And patients were divided into four groups according to different TNM staging.The general data,postoperative complications and follow-up information of patients were statistical analyzed.Results The follow-up end point was in September 2014,the follow-up time was 1 to 67 months with the median time of 11 months.The total follow-up rate of radical group was 88.4% （279/318）.The radical group patients＇ survival rates of half a year,1-year and 2-year were 82.6%,57.9% and 31.1%,with average survival time of （23.2 ±0.4） months.The stage Ⅰ group patients＇ survival rates of half a year,1-year and 2-year were 94.4%,68.2% and 58.7%,with average survival time of （40.3 ± 2.4） months.The stage Ⅱ group patients＇ survival rates of half a year,1-year and 2-year were 85.8%,61.2% and 28.3%,with average survival time of （21.9 ±0.4）months.The stage Ⅲ group patients＇ survival rates of haff a year,1-year and 2-year were 65.0%,41.9% and 19.4%,with average survival time of （15.9 ± 1.2） months.The stage Ⅳ group patients＇ survival rates of half a year,1-year and 2-year were 37.5%,12.5% and 12.5%,with average survival time of （8.5 ±3.2）months.The LogRank test results suggested that the stage Ⅰ and Ⅱ patients＇ survival rate and mean survival time were higher than those of the stage Ⅲ and Ⅳ patients （P 〈 0.05）.Conclusions Radical operation is an effective treatment for pancreatic carinoma patients to obtain long-term survival,especially for stage earlier patients.But to the stage Ⅳpatients,the prognosis of radical operation is poor.