壶腹癌胰十二指肠切除术预后影响因素

Prognostic factors of survival for patients with carcinoma of the ampulla of Vater after pancreatoduodenectomy

目的探讨胰十二指肠切除术后影响壶腹癌患者预后的临床及病理因素。方法对兰州军区乌鲁木齐总医院1994年2月至2009年2月接受胰十二指肠切除手术治疗的壶腹癌患者的临床及病理资料进行回顾性总结，并进行生存统计分析。结果患者术后1、3、5年生存率分别为90％、63％、55％。大多数肿瘤为直径小于2．0cm、T1期、高分化、无淋巴结转移的肿瘤，分别占总例数的58．3％、48．7％、41．7％、73．0％。单因素分析显示，患者性别、年龄、术前胆红素水平、CA19-9测定值、手术方式、活检与否以及肿瘤大小与生存无关；肿瘤大体类型（P=0．018）、组织学类型（P=0．000）、分化水平（P=0．003）、浸润程度（P=0．003）、淋巴结转移情况（P=0．014）以及肿瘤分期（P=0．031）与生存相关。多因素分析显示，肿瘤组织学类型及浸润程度是影响壶腹癌患者长期生存的独立因素（P=0．002、P=0．005）。结论壶腹癌为溃疡型、黏液腺癌、低分化、T2／T3期、有淋巴结转移、Ⅱb期时提示预后不佳。肿瘤组织学类型及肿瘤浸润程度是影响患者生存最重要的危险因素。

Objective To investigate the clinical and pathological prognostic factors in patients with carcinoma of ampulla of Vater treated by pancreatoduodenectomy. Methods The clinical and pathological factors of patients with carcinoma of ampulla of Vater who were operated from February 1994 to February 2009 at the Urumqi General Hospital of Lanzhou Military Region were retrospectively analyzed. The survival curves of these patients were also analyzed. Results The post-operative 1-, 3-, 5-year survival rates were 90% , 63% , 55% respectively. The diameter of the majority of tumor （58.3%） was less than 2.0 cm. Of all the patients with carcinoma of ampulla of Vater, 48.7% were in T1 stage, 41.7% had high grade differ- entiation, 73.0% had no lymphatic metastasis. Univariate analysis showed that gender, age, tumor diame- ter, biopsy or not, the type of operation, the value of pre-operative serum bilirubin and the value of serum CA19-9 were not related to survival. The gross type of tumor （P =0. 018）, histological type （P =0. 000）, grade of differentiation （ P = 0. 003 ）, depth of infiltration （ P = 0. 003 ）, lymphatic metastasis （ P = 0. 014） and TNM stage （P = 0. 031 ） were significant impact factors of survival. Multivariate analysis showed histological type and depth of infiltration were independent prognostic factors of survival （ P = 0. 002, P = 0. 005）. Conclusion Grossly ulcerated carcinoma, mucinous adenocarcinoma on histology, low degree of differentiation, T2/T3 stage, lymphatic metastasis and clinical stage of Ⅱb were all significantly associated with poor prognosis in patients with carcinoma of ampulla of Vater treated by pancreatoduodenectomy. Histological type and the depth of infiltration were the most important risk factors of survival.