胰体尾部癌222例诊治报告

Diagnosis and treatment of carcinoma of pancreatic body and tail: a report of 222 cases

目的 探讨胰体尾部癌的误诊原因、早期诊断及手术治疗价值。方法 对 196 2年 1月至 2 0 0 2年 12月经手术及病理证实的胰体尾部癌 2 2 2例的临床资料进行回顾性分析。结果 本组前2 0年 83例 (37 4 % )分别就诊 2～ 5次 ,仅 13例确诊 ,误诊率为 84 % ;后 2 0年 139例 (6 2 6 % )分别就诊1～ 2次 ,有 83例确诊 ,但多属于中晚期癌 ,仅有 12例为直径 <2 0cm的胰体尾部小胰癌 ,误诊率为4 0 3%。后 2 0年由于影像学技术的应用 ,基因及肿瘤标志物检测 ,以及针吸活检、胰液脱落细胞等病理学诊断 ,使胰体尾部癌的早期发现率由 0提高到 8 6 %。 2 2 2例均行剖腹探查术 ,6例全胰切除术 ,2 0例胰体尾部癌根治性切除术 ,总切除率为 11 7% ,前 2 0年切除率为 0 ,后 2 0年切除率为 18 7%。 5年生存率为 4 6 2 % ,12例小胰癌 5年生存率为 10 0 %。结论 由于对胰体尾部癌认识的提高 ,以及影像学技术在临床上广泛应用 ,可提高早期诊断率。胰体尾部癌惟一有效的治疗方法是外科手术 ,根治性手术切除胰体尾部癌 ,是改善病人预后的关键。

Objective To explore the reasons for misdiagnosis, early diagnosis and evaluate operation for treatment of carcinoma of pancreatic body and tail. Methods The clinical of 222 patients with carcinoma of pancreatic body and tail treated in our hospital from 1962 to December 2002 were retrospectively analyzed. Results Of the 83 patients (37.4%) in the former 20 years coming to our hospital for 2-5 times respectively, only 13 were of confirmed diagnosis and the ratio of misdiagnosis was 84%. Amongst the other 139 patients coming to our hospital for 1-2 times, 83 gotten confirmed diagnosis. However, most of these patients were found to suffer from medium- and late-stage carcinoma and only 12 suffered from little carcinoma (diameter < 2.0 cm). The ratio of misdiagnosis was 40.3%. Due to development in technique of imaging analysis, examination of genes and cancer markers, needle aspiration biopsy and examination of pancreatic fall-off cells in the pancreatic juice, the ratio of early diagnosis of the carcinoma was increased from 0% to 8.6%. Laparotomy was performed in all the 222 patients. Six patients received total pancreatectomy and 20 radical distal pancreatectomy. The ratio of total excision was 11.7%. Meanwhile, the ratio of excision was 0% in the former 20 years but 18.7% in the latter 20 years. For these 222 patients, the 5-year survival rate was 46.2%. It was 100% in the 12 patients with little carcinoma. Conclusions Due to further study on carcinoma of pancreatic body and tail and application of imaging methods, the ratio of early diagnosis of the carcinoma is increased. Operation is the only means for treatment of the carcinoma and radical distal pancreatectomy is very important for improvement of the carcinoma's prognosis.