腹主动脉旁淋巴结阳性的胰头及胆管癌患者术后疗效评估

Efficacy evalualion of aortic lymph node-positive patients with pancreatic and bile duct cancer after operation

目的 研究腹主动脉淋巴结阳性的壶腹周围癌患者的临床特征及术后疗效. 方法 对101例壶腹周围癌患者进行胰切除术,所有切除的标本包括相应的淋巴结均送病理科进行详细的检查.如在淋巴结中发现转移灶即认为是阳性,阳性淋巴结的数量及部位均做详细记录.同时将腹主动脉旁有阳性淋巴结记录的患者15例定为A组,腹主动脉旁无阳性淋巴结记录的患者86例定为B组,对15名经病理证实有腹主动脉旁淋巴结转移的胰头及胆管癌患者进行胰切除术,观察术后两组患者的生存率和术后生存曲线. 结果 术后患者1、2、3年生存率分别为33%、27%和0,平均生存12个月（3～33个月）.无腹主动脉旁淋巴结转移的胰头癌及胆管癌患者的生存曲线明显好于那些有淋巴结转移的患者（P＜0.01）. 结论 腹主动脉旁淋巴结转移的患者术后生存率较低,因而不应再进行扩大切除术.

Objective To explore the clinicopathologic features and surgical Results of paraaortic node-positive periampullary adenocarcinoma. Methods 101 patients underwent pancreatectomy with regional and paraaortic lymphadenectomy.Fifteen（15%）patients had histologically proven paraaortic lymph node disease. Results The 15 patients included 9（26%）of 34 patients with pancreatic head carcinoma and 6（17%）of 36 patients with bile duct adenocarcinoma.All 15 patients had locally advanced tumor invading adjacent structures.The 1-,2-,and 3-year survival rates were 33%,27%,and 0%,with median survival of 12 months（range from 3 to 33months）.In patients with pancreatic head carcinoma or bile duct adenocarcinoma,survival curve for those without paranortic lymph node metastasis was significantly better than those with involved paraaortic lymph nodes（P〈0.01）. Conclusion When the paraaortic lymph nodes obtained from sampling biopsy were histologically positive,radical pancreatectomy with extended lymphatic and soft tissue clearance should be abandoned owing to poor outcome.