胰腺腺鳞癌8例临床分析

Clinical analysis of pancreatic adenosquamous carcinoma: a report of 8 cases

目的 胰腺腺鳞癌是一种临床罕见的胰腺外分泌恶性肿瘤 ,本文探讨其临床病理学特点和诊断治疗方法。方法 回顾性分析 8例胰腺腺鳞癌的临床特点并结合文献讨论。结果 本组 8例胰腺腺鳞癌病人 ,其中男 7例 ,女 1例 ,平均年龄 (6 9 3± 11 8)岁。肿瘤位于胰头 5例 ,胰体 2例 ,胰尾 1例。行胰头十二指肠切除术 4例 ,其中 1例行保幽术式 ,1例合并区域淋巴结清扫术 ,1例合并肠系膜上动、静脉切除重建术。另 1例胰头肿块术中发现肝转移 ,行胆囊空肠襻式吻合术 ;3例胰体尾肿块 ,2例行胰体尾切除、脾切除术 ,另 1例肿瘤已侵犯胃底 ,行胰体尾、脾脏切除术合并部分胃切除术。病理检查 :瘤体平均 4 5cm ,肿瘤原发灶和肝转移灶均呈腺癌和鳞癌混杂表现。肿瘤呈浸润性生长的特点。 5例胰头肿块中 ,肿瘤侵犯十二指肠 2例 ,侵犯肠系膜上静脉 1例 ,肝转移 1例 ;1例胰体肿瘤侵犯脾静脉 ,1例胰尾肿瘤侵犯胃壁肌层。镜下见肿瘤侵犯神经 2例 ,淋巴结转移 2例。随访 6例 ,术后生存 3～ 7个月 ,平均生存 5 5个月 ,均死于肿瘤复发和肝转移。结论 胰腺腺鳞癌以腺癌和鳞癌混合为组织学特点 ,呈侵袭性生长的特点 ,易侵犯周围脏器、大血管和肝脏、淋巴结转移 ,恶性程度高 。

Objective To investigate the clinicopathological features and diagnostic and therapeutic methods of pancreatic adenosquamous carcinoma, a rare variant of exocrine pancreatic neoplasm. Methods A retrospective clinical analysis was conducted in 8 cases of pancreatic adenosquamous carcinoma treated in our hospital from 1989 to 2000. Results Pancreatic adenosquamous carcinoma was found in 7 men and 1 women with a mean age of 69 3±11 8. Tumor location was in the head of pancreas in 5 patients, body in 2 and tail in 1. The tumor was surgically resected in 7 patients. Of the 7 patients, 1 received pylorus preserved pancreaticoduodenectomy, 1 pancreaticoduodenectomy, 1 pancreaticoduodenectomy in combination with resection and reconstruction of superior mesenteric vein (SMV) and superior mesenteric artery (SMA), 2 distal pancreatectomy and 1 distal pancreatectomy in combination with partial gastrotectomy. The other 1 patient with liver metastasis was treated with palliative operation. Follow up suggested that the prognosis was poor and the mean survival time was 5.5 months after the operation. All patients died of tumor recurrence and liver metastasis. Conclusions Pancreatic adenosquamous carcinoma is characterized by the mixture of adenomatous and squamous cell elements and demonstrates aggressive biological behavior. Invasion to adjoined organ and metastasis are usual. The prognosis of this admixed tumor appears to be even less favorable than the invasive ducta tumor.