淋巴结转移、神经侵犯对胰头部小胰癌预后的影响

Influence of lymph node metastases and perineuronal invasion on prognosis of small pancreatic carcinoma

目的:探讨有无淋巴转移、神经侵犯对胰头部小胰癌预后的影响。方法:回顾性分析1996年1月至2004年12月收治的48例胰头部小胰癌的临床资料。结果:本组48例中,男29例,女19例,年龄30～83岁。病理检查:肿瘤直径均在2cm以下,管状腺癌45例,乳头状腺癌2例,腺鳞癌1例。分化程度:高分化8例,中分化33例,低分化7例。淋巴结转移17例,胰周神经侵犯25例。随访表明,无淋巴结转移和神经侵犯的病例术后平均生存(28.7±16.8)个月,比有淋巴结转移和(或)胰周神经侵犯的明显延长(P<0.01)。结论:淋巴结转移和神经侵犯是小胰癌重要的预后因素。胰头部小胰癌超过半数以上存在淋巴结转移和神经侵犯,应扩大淋巴结清扫范围和广泛的腹膜后软组织切除以争取较好的预后。

Objective：To investigate the influence of lymph node metastases and perineuronal invasion on the prognosis of small pancreatic carcinoma. Methods： The clinical data of 48 patients （admitted from Jan. 1996 to Dec. 2004） with small pancreatic carcinoma were retrospectively analyzed. Results： The 48 patients included 29 men and 19 women with an age range of 30-83 years. Post-operative pathological examination confirmed that there were 45 cases of tubular adenocarcinoma, 2 cases of papillary adenocarcinoma and 1 case of adenosquamous carcinoma, with the diameter of all tumors less than 2 cm. The well-,moderately- and poorly-differentiated tumors were found in 8, 33 and 7 patients, respectively. Lymph node metastases were found in 17 cases and perineuronal invasion in 25 cases. Follow-up results suggested that the patients without lymph node metastases and perineuronal invasion had a relatively longer survival time （[28.7±16.8] months） than those with lymph node metastases or perineuronal invasion （P〈0.01）. Conclusion： Lymph node metastasis and perineuronal invasion are important prognostic factors for small pancreatic carcinoma. Because more than half of the small pancreatic carcinomas have lymph node metastasis or perineuronal invasion, radical resection with extensive soft tissues and lymph node clearance should be performed to improve prognosis.