胰体尾癌的诊治:附45例报告

Diagnosis and treatment of carcinoma of pancreatic body and tail: a report of 45 cases

目的:探讨胰体尾癌的临床诊断及治疗效果。方法:回顾安徽医科大学附属省立医院2001年1月—2014年12月收治的45例胰体尾癌患者的临床资料,分析其诊断、治疗及预后。结果:45例患者主要表现为不典型的上腹部疼痛(37/45);CA19-9阳性率71.1%(32/45);胰体尾占位检出率B超为92.5%(37/42),CT为97.8%(44/45)。患者均行手术探查,其中行根治性手术27例,姑息性旁路引流手术3例,其余15例仅行肿瘤活检+无水酒精注射。围手术期并发症主要为胰瘘,其发生率为6.7%(3/45),术后总体的中位生存时间11个月,行根治性切除患者的中位生存时间为15个月,非根治性手术患者的中位生存时间为5个月,差异有统计学意义(χ2=47.1,P<0.05)。结论:胰体尾癌临床症状不典型,早期诊断困难,总体预后差,只有提高早期诊断率和实施根治性手术有利于改善患者的预后。

Objective：To investigate the clinical diagnosis and treatment efficacy of carcinoma of pancreatic body and tail.Methods：The clinical data of 45 patients with carcinoma of pancreatic body and tail treated in the Affiliated Provincial Hospital of Anhui Medical University from January 2001 to December 2014 were reviewed.The diagnosis,treatment and outcomes of the patients were analyzed.Results：Of the 45 patients,the main symptom was atypical upper abdominal pain（37/45）;CA19-9 positive rate was 71.1%（32/45）;the detection rate of occupying lesion in the body and tail of the pancreas by B ultrasound and CT was 92.5%（37/42） and 97.8%（44/45）,respectively.All patients underwent surgical exploration that included radical resection in 27 cases,palliative bypass drainage in 3 cases,and tumor biopsy plus anhydrous ethanol injection in 15 cases.The perioperative major complication was pancreatic fistula,the incidence of which was 6.7%（3/45）.The overall postoperative median survival time was 11 months,in which the median survival time for patients undergoing radical resection was 18 months,and for those undergoing non-radical resection was5 months,and the difference had statistical significance（χ2 =47.1,P〈0. 05）.Conclusion：The clinical symptoms of carcinoma of pancreatic body and tail are atypical,early detection of this disease is difficult,the overall prognosis is poor,and only the promotion of early diagnosis and radical surgery can help improve the patients＇ prognosis.