胰体尾腺癌的外科治疗

Surgical therapy of adenocarcinoma of body and tail of pancreas

目的研究胰体尾腺癌的临床特点、肿瘤行为和外科治疗效果。方法回顾性分析1980年1月至2006年8月我院腹部肿瘤外科收治的有明确病理学诊断的108例胰体尾腺癌病人的临床病理资料。结果84%(91例)为导管腺癌。46%(50例)出现同时性远处转移,血行转移40%(43例)以肝转移为主(41例,38%),种植转移19例(18%)。54%(58例)切除了肿瘤,Ⅰ、Ⅱ、Ⅲ、Ⅳ期病人手术切除率分别为100%(5例)、100%(33例)、5%(1例)和38%(19例),差异显著(x^2= 56.80,P<0.001)。和未切除肿瘤的病人相比,手术切除病人的男性比例(53%;72%,x^2=3.92,P=0.048)显著较少,出现上腹痛(66%:84%,x^2=4.78,P=0.029)、体重下降(22%:42%,x^2= 4.78,P=0.029)和种植转移的比例(0:38%,x^2=26.74,P<0.001)显著较低。Ⅰ、Ⅱ、Ⅲ、Ⅳ期病人中位生存分别为35(11～73)、14(1～83)、6(2～25)和4(1～20)个月,存在显著性差异(x^2=30.07,P<0.001)。Ⅲ、Ⅳ期胰体尾腺癌手术切除后中位生存8(2～25)个月,显著长于未切除病人的4(1～13)个月(x^2=17.06,P<0.001)。结论胰体尾腺癌手术时出现同时性远处转移的几率大。男性、上腹痛、体重下降、种植转移时手术切除的可能性降低。Ⅲ期病人虽然手术切除率较Ⅳ病人为低,但是术后生存无显著差异;对Ⅲ、Ⅳ期胰体尾癌而言,原发灶能够切除的病人术后生存期较长。

Objective To analyze the clinical presentations, oncological behavior of and surgical effects on adenocarcinoma of the left pancreas. Methods The clinical data of 108 patients with adeno- carcinoma of the body and tail of the pancreas treated in our hospital from January 1980 to August 2006 were retrospectively analyzed. Results Ninety-one patients （84%） suffered from ductal adeno carcinoma. Forty-three patients （400/00） had hematogenous metastasis （liver predominantly, n = 41） and 19 （18%） cavity implantation. Fifty eight patients （540/00） underwent tumor removal, and the re moval rate was significantly different among patients with stage Ⅰ （100%, 5/5）, Ⅱ （100%, 33/33）,Ⅲ（5%, 1/20） and Ⅳ （38%, 19/50） disease（χ^2=56.80,P〈0. 001）. There were few male （53% ： 72%, χ^2=3.92,P=0.048）, less abdominal pain （66% ： 84%, χ^2=4.78,P=0.029）, weight loss （22% ： 42%,χ^2 =4.78,P= 0.029）, abdominal and pelvic carcinomatosis （0：38%,χ^2 =26.74, P〈 0. 001） in patients with tumor removal than those without. The median survival was markedly differ ent among patients with stage Ⅰ （35 （11～73） months）, Ⅱ （14 （1Ⅱ83） months）,Ⅲ （6 （2Ⅲ25） months） and Ⅳ （4 （1～20） months） disease （χ^2 = 30.07, P〈0. 001）. Resection of primary tumor could get a median survival of 8 （2～25） months, longer than those could not in stage Ⅲ and Ⅳ disease （χ^2 = 17.06, P〈0. 001 ）. Conclusion Concomitant distant metastasis （especially in the liver） was high in adenocarcinoma of the body and tail of the pancreas. Male patients, symptoms such as abdomi nal pain or weight loss, exist of cavity implantation can decrease the resection possibility. Although the resection rate is lower in stage Ⅲ patients than those in stage IV, but there is no significant differ ence in postoperative survival, only those who had their tumor resected can get a longer survival.