胰头癌与壶腹癌可切除性及临床行为特点差异的比较研究

Differences between pancreatic head and ampullary cancer in resectability and biological features

目的探讨胰头癌与壶腹癌在可切除性、肿瘤局部浸润、血管侵犯、淋巴结转移、远处转移、预后等临床行为特点的差异。方法同期收治的胰头癌42例、壶腹癌26例为本研究对象，以手术发现和病理诊断作为金标准，探讨上述指标两组之间的差异。结果同期收治的壶腹癌26例和胰头癌42例中，壶腹癌切除率84．62％，胰头癌的手术切除率为19．05％，胰头癌发生血管侵犯为83．33％，壶腹癌为11．54％，两组间均存在显著差异（P〈0.01）。在肿瘤局部组织浸润（P=0.13）、淋巴结转移（P=0．15）、远处转移（P=0.54），两组间无差异；两组TNM分期构成亦存在明显差异（P〈0．01）。结论壶腹癌与胰头癌因其原发组织、生长部位不同，其临床行为特点各异，术前应力争明确肿瘤部位以利于制定正确治疗方案。

Objective To investigate the differences between pancreatic head and ampullary cancer in resectability, local extension, vascular invasion, lymph node involvement, distant metastasis and prognosis. Methods The clinical data of 26 patients with histologically proven carcinoma of Vater＇s ampulla were compared with those of 42 patients with pancreatic head carcinoma. The surgical findings and pathological results were used as the golden standard. Results The resectable rate was significantly higher but vascular invasion rate lower in ampullary carcinoma than in pancreatic head carcinoma （P〈0. 01 ）. There were no marked differences between the 2 groups in local extension, lymph node involvement and distant metastasis （P〉0. 05）. Conclusions The 2 types of carcinoma have different biological features due to differences in histogenesis and organogenesis. So it is important to make clear diagnoses before operation.