胰管结石合并周围恶性肿瘤的危险因素分析

Risk factors analysis of pancreatic ductal stones combined with malignant tumor beside stones

目的:探讨胰管结石合并周围恶性肿瘤的危险因素。方法:采用回顾性病例对照研究方法。收集2008年1月至2017年6月陆军军医大学(第三军医大学)第一附属医院收治的190例行手术治疗的胰管结石患者的临床病理资料。190例患者中,胰管结石单纯合并慢性胰腺炎175例,胰管结石合并周围恶性肿瘤15例。观察指标:(1)胰管结石合并周围恶性肿瘤的危险因素分析。(2)随访和生存情况。采用门诊和电话方式进行随访,了解胰管结石合并周围恶性肿瘤患者治疗情况及获得随访患者术后生存情况。随访时间截至2017年12月。单因素分析采用X2检验或Fisher确切概率法或秩和检验,多因素分析采用Logistic回归模型。采用Kaplan-Meier法绘制生存曲线和计算生存率。结果:(1)胰管结石合并周围恶性肿瘤的危险因素分析:单因素分析结果显示:血清肿瘤标志物升高、胰管结石直径、胆总管扩张或受压、胰腺明显萎缩是影响胰管结石合并周围恶性肿瘤的相关因素(X2=12.501,Z=-2.508,X2=12.230,5.863,P<0.05)。多因素分析结果显示:血清肿瘤标志物升高、胆总管扩张或受压、胰腺明显萎缩是胰管结石合并周围恶性肿瘤的独立危险因素(优势比=5.482,8.062,4.993,95%可信区间:1.556~19.313,1.620~40.107,1.188~20.977,P<0.05)。(2)随访和生存情况:190例患者中,162例获得术后随访,其中胰管结石单纯合并慢性胰腺炎患者149例,胰管结石合并周围恶性肿瘤患者13例;随访时间为2~111个月,中位随访时间为20个月。随访期间,13例胰管结石合并周围恶性肿瘤患者术后1、3、5年总体生存率分别为46.7%、6.7%、0,其中仅3例行术后辅助化疗;149例胰管结石单纯合并慢性胰腺炎患者术后1、3、5年总体生存率分别为97.0%、93.5%、91.6%。结论:血清肿瘤标志物升高、胆总管扩张或受压、胰腺明显萎缩是胰管结石合并周围恶性肿瘤的独立危险因素。

Objective:To investigate the risk factors of pancreatic ductal stones (PDS) combined with malignant tumor beside stones.Methods:The retrospective case control study was conducted. The clinicopathological data of 190 patients with PDS who underwent surgical treatment at the First Affiliated Hospital of Army Medical University (Third Military Medical University) between January 2008 and June 2017 were collected. Of 190 patients, 175 and 15 were detected PDS complicated with chronic pancreatitis and malignant tumor beside stones respectively. Observation indicators: (1) risk factors analysis of PDS combined with malignant tumor beside stones; (2) Follow-up and survival situations. Follow-up using outpatient examination and telephone interview was done to detect treatment of patients who had PDS combined with malignant tumor beside stones and postoperative survival up to December 2017. Univariate analysis was done by chi-square test, Fisher exact probability or rank sum test, and multivariate analysis was done using Logistic regression model. The survival curve was drawn and survival rate was calculated by Kaplan-Meier method.Results:(1)Risk factors analysis of PDS combined with malignant tumor beside stones: results of univariate analysis showed that increased serum tumor markers, diameter of PDS, common bile duct dilation or compression, pancreatic parenchymatous atrophy were related factors affecting PDS combined with malignant tumor beside stones (X2=12.501, Z=-2.508, X2=12.230, 5.863, P<0.05). Results of multivariate analysis showed that increased serum tumor markers, common bile duct dilation or compression, pancreatic parenchymatous atrophy were independent risk factors affecting PDS combined with malignant tumor beside stones (odds ratio: 5.482, 8.062, 4.993, 95% confidence interval: 1.556-19.313, 1.620-40.107, 1.188-20.977, P<0.05). (2) Follow-up and survival situations: 162 of 190 patients were followed up for 2-111 months with a median time of 20 months, including 149 of PDS complicated with chronic pancreatitis and 13 of PDS combined with malignant tumor beside stones. During the Follow-up, the 1, 3, 5year overall survival rates after operation were 46.7%, 6.7% and 0 in 13 patients of PDS combined with malignant tumor beside stones, and 3 patients received postoperative chemotherapy. The 1, 3, 5year overall survival rates of the 149 patients who had PDS combined with chronic pancreatitis were 97.0%, 93.5%, 91.6%.Conclusion:Increased serum tumor markers, common bile duct dilation or compression, pancreatic parenchymatous atrophy are independent risk factors affecting PDS combined with malignant tumor beside stones.