胰腺癌的临床诊治分析

Clinical diagnosis and treatment of pancreatic carcinoma

目的探讨胰腺癌患者的临床诊治过程中的症状表现、诊断方法、治疗方法及治疗效果。方法选取2016年1月至2017年12月间南京医科大学第二附属医院胰腺中心收治的经手术治疗的98例胰腺癌患者的病例资料进行回顾性分析,从首发症状、确诊时间、实验室及影像学检查、治疗方法、术后病理分型分期以及生存时间等方面进行统计。结果胰腺癌患者的首发症状:以食欲减退(31.6%)、上腹胀痛(24.5%)和消瘦(20.4%)为主。胰腺癌患者从首发症状到确诊的时间:主要集中在9~11个月(38.8%),平均11个月。胰腺癌患者影像学及实验室检查的阳性率:腹部增强CT诊断阳性率为90.2%,腹部磁共振成像诊断阳性率为87.3%,影像学联合肿瘤标志物诊断阳性率为91.4%。胰腺癌患者治疗方法:根治性手术切除38例(38.8%),氩氦刀冷冻消融治疗34例(34.7%),仅行姑息性手术治疗26例(26.5%)。胰腺癌患者术后病理分期:Ⅰ期8例,Ⅱ期27例,Ⅲ期36例,IV期27例。胰腺癌患者采用根治性手术、氩氦刀冷冻消融治疗术及姑息性手术的中位生存期分别为15.5个月、8.5个月及4.3个月。结论针对临床出现上腹胀痛、消瘦以及食欲减退的高危患者,行影像学联合肿瘤标志物的检查对于早期胰腺癌的检出至关重要,根治性手术仍然是胰腺癌首选的治疗方法,而对于局部进展期患者,氩氦刀冷冻消融术是缓解疼痛、延长生存时间的可供选择方式。

Objective To analyze and summarize the symptom dimenstration,diagnosis methods,treatment strategies and treatment efficacy in the clinical diagnosis and treatment of pancreatic carcinoma.Methods Data of 98 patients with pancreatic cancer treated by operation at The Second Affiliated Hospital of Nanjing Medical University from January 2016 to December 2017 were analyzed retrospectively. The initial symptoms,time of diagnosis,laboratory and imaging examination,treatment methods,postoperative pathological stages and survival time were counted. Results The initial symptoms mainly manifested as loss of appetite（ 31. 6%）,epigastric pain（ 24. 5%）,and weight loss（ 20. 4%）. Time from the initial symptoms presence to the diagnosis was about 9 to 11 months（ 38. 8%）,with the average of 11 months. For the positive rate of imaging and laboratory examinations,the positive rate of abdomen-enhanced CT diagnosis was 90. 2%,the positive rate of abdominal magnetic resonance imaging was 87. 3%,and the positive rate of imaging combined with tumor marker diagnosis was 91. 4%. For the treatment,38 patients（ 38. 8%） underwent radical surgical resection,34 patients（ 34. 7%） were treated with argon-helium cryoablation,and26 patients（ 26. 5%） underwent palliative surgery only. For the postoperative pathological stage,stageⅠ 8 patients,stage Ⅱ 27 patients,stage Ⅲ 36 patients,and stage Ⅳ 27 patients. The median survival durations for radical surgery,argon-helium cryoablation,and palliative surgery was 15. 5 months,8. 5 months and 4. 3 months respectively. Conclusion For high-risk patients with clinical abdominal pain,weight loss,and loss of appetite,imaging combined with tumor markers examination is critical for early detection of pancreatic cancer. Radical surgery is still the preferred treatment for pancreatic cancer. Argon helium cryoablation or locally advanced patients is an alternative way to relieve pain and prolong survival.