Vater壶腹腺癌胰十二指肠切除后复发转移的危险因素

Postoperative recurrence and metastasis in patients of the ampulla of Vater adenocarcimona

目的研究Vater壶腹腺癌在胰十二指肠切除后复发转移的危险因素。方法回顾性分析1980年1月至2003年12月收治的胰十二指肠切除后存活的101例Vater壶腹腺癌的临床病理资料。结果本组患者中TNM分期Ⅰ期42例（41．6％），Ⅱ期32例（31．7％），Ⅲ期27例（26．7％）。中位随访时间为46（2～192）个月，25例（24．8％）复发转移，中位复发转移时间为20（2～93）个月。局部复发11例（10．8％），远处转移20例（19．6％），其中6例同时出现局部复发与远处转移。复发转移的25例患者与未复发转移的76例患者的肿瘤最大直径〉2cm（64％比39％，x^2=4．56，P=0．033）、淋巴结阳性率（52％比17％，x^2=11．98，P=0．001）和手术并发症发生率（51％比20％，x^2=7．50，P=0．006）之间相比差异有统计学意义。Logsitic回归分析发现，只有淋巴结转移（OR=5．14，P=0．0037）是复发转移的独立预后因素。未出现淋巴结转移患者中位无复发生存时间为49（2～192）个月，淋巴结转移患者为32（12—152）个月，两者相比差异有统计学意义（x^2=5．43，P=0．0198）。结论Vater壶腹腺癌在胰十二指肠切除后复发转移较为常见；淋巴结转移是术后复发转移的独立危险因素。

Objective To identify the prognostic factors influencing the recurrence and metastasis of adenocarcinoma of the ampulla of Vater after panreaticoduodenectomy. Methods A retrospective study was carried out on the clinical manifestation, pathological behavior and survival data in 101 patients with Vater＇s ampullary adenocarcinoma receiving pancreaticoduodenectomy from Jan 1980 to Dec 2003. Results According to TNM system, there were 42 cases （41.6%） of stage Ⅰ , 32 cases （31.7%） of stage Ⅱ , 27 cases （26.7%） of stage Ⅲ. During postoperative follow-up period [ median, 46 （2 - 192） months] 25 patients （24. 8% ） suffered from recurrence or/and metastasis with the median recurrence time of 20 （2 -93） months, among which there were 11（10. 8% ） cases of local recurrence and 20（19.6% ） cases of distant metastasis. The differences were statistically significant between the patients with recurrence or/and metastasis and those without in the following parameters： tumor size larger than 2 cm （64% vs, 39% , x^2 = 4. 56, P =0. 033）, positive lymph node metastasis in the primary specimens （52% vs. 17% , x^2 = 11.98, P =0. 001 ） , postoperative complications （ 51% vs. 20%, x^2 = 7.50, P = 0. 006 ）. Logistic regression showed only lymph node status （OR = 5.14, P = 0. 0037） was independent factors of tumor recurrence and metastasis. The median non-recurrent time in those without lymph node metastasis was 49 （2 - 192 ） months, significantly longer than the median 32 （12 -152） months in those with metastasis （x^2 = 5. 43, P =0. 0198, log-rank test）. Conclusions Recurrent metastasis is the main problem in patients with ampullary adenocarcinoma after pancreaticoduodenectomy. The lymph node status is an independent prognostic factor.