瓦特壶腹癌行胰十二指肠切除术后生存相关因素分析

Determinants of long-term survival after pancreaticoduodenectomy for ampulla of Vater carcinoma

目的探讨瓦特壶腹癌胰十二指肠切除术后长期生存的相关因素，从而制订出更具针对性的治疗方案。方法回顾性分析解放军总医院1997年1月至2005年9月问收治的行胰十二指肠切除术的77例瓦特壶腹癌患者的临床资料，采用Kaplan-Meier法进行生存分析，独立样本t检验进行统计学比较，应用COX比例风险模型进行多因素分析。结果全组无手术死亡，总的5年生存率为40．7％；单因素分析表明，术前癌胚抗原（CEA）水平（P=0．012）、肿瘤浸润深度（P=0．000）、TNM分期（P=0．000）、肿瘤直径（P=0．001）是影响瓦特壶腹癌患者术后生存时间的相关因素；多因素回归分析显示肿瘤直径是有统计学意义的独立预后指标（P=0．000）。结论瓦特壶腹癌行胰十二指肠切除术后预后良好，肿瘤直径是惟一影响预后的独立相关因素，而术前CEA水平、肿瘤浸润深度、TNM分期可能也对术后生存时间有一定影响，还需进一步行随机分组对照前瞻性研究来明确。

Objective To investigate the determinants of long-term survival for ampulla of Vater carcinoma treated by panereaticoduodenectomy. Methods A total of 77 patients with ampulla of Vater carcinoma undergoing pancreatieoduodenectomy were reviewed. Kaplan-Meier method was used to analyze the survival rate. Independent t test was used for statistical comparison and COX regression model for multivariate analysis. Results No patient died as a result of surgery. The overall 5-year survival was 40. 7%. Univariate analysis showed that perioperative serum carcinoembryonic antigen （CEA） level （P = 0. 012） , tumor invasion depth （ P = 0. 000 ） , UICC stage （ P = O. 000 ） and tumor size （ P = 0. 001 ） were significant prognostic factors of ampulla of Vater carcinoma ; in multivariate analysis, only the tumor size （P = 0. 000 ） was an independent prognostic factor of ampulla of Vater carcinoma. Conclusion Pancreaticoduodenectomy is associated with significant survival. Tumor size is the most important influencing factor of outcome after pancreatieoduodeneetomy; in addition, perioperative serum CEA level, tumor invasion depth and UICC stage may also influence the survival rate, there exists a need for further follow-up studies.