胆总管浸润对Vater壶腹腺癌胰十二指肠切除预后的影响

Prognostic implication of common bile duct infiltration in adenocarcinoma of the ampulla of Vater after pancreaticoduodenectomy

目的研究胆总管浸润对Vater壶腹腺癌胰十二指肠切除的预后影响。方法回顾性分析胰十二指肠切除后存活的102例Vater壶腹腺癌患者的临床病理和生存资料，比较胆总管浸润和无浸润之间的差异。结果T1期9例（8．8％），他期40例（39．2％），13期25例（24．5％），T4期28例（27．5％）；NO76例（74．5％），N1 26例（25．5％）。TNM分期Ⅰ期42例（41．2％），Ⅱ期32例（31．3％），Ⅲ期27例（26．5％），Ⅳ期1例（1．0％）。胆总管浸润26例（25．5％），无胆总管浸润76例（74．5％）。胆总管浸润组出现胰腺浸润22例（84．6％），无胆总管浸润组为26例（34．2％），差异有统计学意义（x^2=19．78，P〈0．001）。全组有25例（24．5％）出现复发转移，中位复发转移时间为20（2～93）个月。无胆总管浸润组患者的术后中位无复发生存期和总体生存期显著优于胆总管浸润组。结论胆总管浸润的Vater壶腹癌患者易出现胰腺浸润，无复发生存期和总体生存期显著下降，患者术后应该接受综合治疗。

Objective To investigate the prognostic implication of common bile duct infiltration in the adenocarcinoma of the ampulla of Vater after panreaticoduodenectomy. Methods A retrospective study was conducted on clinical manifestation, pathological behavior and survival data in 102 patients with Vater＇s ampulla adenocarcinoma, who underwent pancreaticoduodenectomy from Jan 1980 to Dec 2003. The result of patients with the common bile duct infiltration were compared with that of those without. Results There were 42 cases in stage Ⅰ （41.2%）, 32 in stage Ⅱ （31.3%）, 27 in stage Ⅲ （26.5%）, and 1 in stage Ⅳ （1.0%）. As for T stage ： 9 cases in stage T1 （8.8%）,40 in T2 （39.2%）,25in T3 （24.5%）, and 28 in T4 （27.5%）. As regarding to N stage： 76 cases in stage NO （74.5%） and 26 in N1 （25.5%）. Of these 102 cases, microscopic infiltration in the common bile duct （25.0%） was identified in 26 cases. A significant difference was observed between the patients with bile duct infiltration and those without, in the proportion of pancreatic medullae infiltration： 84.6% （ infiltration group） versus 34.2% （ non-infiltration group, P 〈 0. 001 ）. Twenty-five cases （24.5%） had recurrence and/or metastases postoperatively, with a median survival of 20 months （ range, 2 to 93 months）. The overall median survival of the whole group was 46.0 months （2 - 192 months） , with a significant difference between the common bile duct infiltration group （36 months） and the non-infiltration group （49 months, P = 0. 0061 ）. The median non-recurrence survival of the whole group was 43 months （2 -192 months）, and a significant difference was observed between the common bile duct infiltration group （35 months） and non-infiltration group （ 47 months, P = 0. 0002）. Conclusion If the adenocarcinoma of the Vater＇s ampulla infiltrated the common bile duct, the invasion to the pancreatic medulla is likely developed, and usually with a poor non-recurrence and overall survival. Therefore, postoperative chemotherapy/radiotherapy is suggested.