胰腺腺鳞癌六例临床分析

Treatment of pancreatic adenosquamous carcinoma, a study of 6 cases

目的探讨胰腺腺鳞癌的生物学特征及临床治疗方法。方法回顾性分析我院 1995年-2005年间收治的6例胰腺腺鳞癌的临床特点、影像学改变、病理学特征、治疗过程及随访资料并结合文献讨论。结果本组6例胰腺腺鳞癌患者．平均年龄(51．8±10．8)岁。肿瘤位于胰头 4例,胰体尾1例,胰尾1例。行胰头十二指肠切除3例,其中一例因为肿瘤侵犯门静脉行门静脉切除、人造血管重建术。行胰体尾切除、脾切除术1例。1例胰头肿块术中发现肿瘤广泛浸润,行胰腺肿块活检和空肠造瘘术。1例肿瘤已侵犯胃底,行胰体尾、脾脏切除合并部分胃切除。病理检查:瘤体平均5．2 cm×4．1 cm×3．0 cm,肿瘤原发灶和肝转移灶均呈腺癌和鳞癌混杂表现。肿瘤呈浸润生长的特点。4例胰头肿瘤中侵犯十二指肠、胆总管3例,侵犯包绕门静脉1例。肿瘤侵犯神经4例,淋巴结转移3例。随访6例,死亡4例术后生存6-8个月,平均生存6．7个月,均死于肿瘤复发和肝转移。结论胰腺腺鳞癌以腺癌和鳞癌混合为组织学特点,恶性程度高,预后差。

Objective To investigate the biological features and treatment of pancreatic adenosquamous carcinoma. Methods A retrospective clinical analysis was conducted in 6 cases of pancreatic adenosquamous carcinoma treated in our hospital from 1995 to 2005. The clinical features, imaging findings, therapy and pathology were analyzed. Results Pancreatic adenosquamous carcinoma was found in 3 men and 3 women with a mean age of 51.8 ± 10. 8 years. Tumor was located in the head of the pancreas in 4 patients,body in 1 and tail in 1. Three cases received pancreaticoduodenectomy, two did distal pancreatectomy and splenectomy, one underwent palliative operation. The mean size of the tumor was 5. 2 cm × 4. 1 cm × 3.0 cm, pathologically primary tumor and the liver metastasis were mixture of adenocarcinoma and squamous cell carcinoma. Tumor invaded the duodenal wall and common bile duct in 3 cases, portal vein was invaded in 1 case. Neural invasion was present in 4 cases. Lymphatic invasion was found in 3 cases. Postoperative mean survival time was 6. 7 months after the operation with patients finally dying of tumor recurrence and liver metastasis. Conclusions Pancreatic adenosquamous carcinoma is characterized by the mixture of adenomatous and squamous cell element with aggressive biological behavior. The prognosis of this tumor is poor demanding early diagnosis and proper surgical treatment.