手术治疗胰体尾癌26例临床分析

CLINICAL ANALYSIS OF 26 CASES OF SURGICAL THERAPY OF TUMOR OF BODY AND TAIL OF PANCREAS

目的探讨胰体尾癌外科治疗方法和根治性切除的影响因素。方法回顾性分析手术治疗26例胰体尾癌病例的临床病理资料。结果肿瘤侵犯横结肠者2例,脾脏者2例;侵犯脾动静脉14例,门静脉、肠系膜上静脉2例,肠系膜上动脉、腹腔干8例。肿瘤直径小于4cm11例,4～8cm13例,大于10cm2例,根治性切除组肿瘤直径平均为3.8cm(2例胰腺囊腺癌除外),姑息性切除组肿瘤直径平均为5.4cm。根治性切除18例,姑息性切除8例,胰体尾切除加脾切除24例,门静脉、肠系膜上静脉局部楔行切除修补2例,胰体尾切除加脾切除加横结肠切除2例。根治性切除组与姑息性切除组中位生存时间分别为18.6个月和10.3个月。结论积极行手术切除肿瘤是胰体尾癌患者获得长期生存的唯一途径,而肿瘤的大小、对重要血管和邻近脏器的侵犯程度是影响肿瘤能否根治性切除的重要因素。

Objective To explore surgery therapy and factors influencing the prognosis of ratical resection of tumor of body and tail of the pancreas. Methods From January 1996 to December 2006, the clinical deta of 26 cases of tumor of tail and body of pancreas who underwent operation were retrospectively analysed. Results Of all the cases ,2 cases invased transverse colon,2 invased spleen,14 invased vessel of spleen ,2 invased PV/SMV and 8 cases invased superior mesenteric artery and celiac trunk . The average diameter of tumor of the redical operation group, exceptively 2 cases mucinous cystic tumor, is 3.8 cm. The palliative operation group is 5.4 cm. 18 cases underwent radical operation. 8 cases underwent palliative operation. Surgical removal of body and tail of pancreas and resection of spleen were subjected to 24 cases ,2 cases to SMV-PV lateral wall partial resection and reconstruction,2 to resection of body and tail of pancreas and resection of spleen and transverse colon. The median survival of the redical operation group and palliative operation group was 18.6 months and 10. 3 months. Conclusions Surgical therapy is the only one approath to prolong patients, survival. The diameter of tumor, the degree of tumor invasiving adjacent important vessel and organs are the factors influence radical resection of the cancer.