胰腺腺鳞癌2例报告及文献综述

Adenosquamous carcinoma of the pancreas: a report of 2 cases and literature review

目的探讨胰腺腺鳞癌的临床特征、病理学特点、治疗方法和预后情况,以提高认识和诊治水平。方法回顾性分析皖南医学院弋矶山医院肝胆外科2014年3月和2015年1月分别收治的2例胰腺腺鳞癌病人的临床资料并结合相关文献进行分析讨论。结果 2例胰腺腺鳞癌病人中男女各1例,术前相应的影像学检查提示:胰腺占位性病变,病灶都位于胰腺头部,1例以上腹部胀痛不适入院,另1例以巩膜黄染、尿黄入院。术前血清肿瘤标志物糖类抗原199(CA199)均增高。完善相关检查后,两者均行手术治疗,1例行完全腹腔镜下胰十二指肠切除术,另1例行腹腔镜辅助下胰十二指肠切除术,术后均辅助以化疗。术后病理提示为胰腺腺鳞癌。术后病人得到有效随访。其中1例随访至术后22个月因肿瘤复发死亡,另1例病人因肝脏多发转移于术后第10个月死亡。结论胰腺腺鳞癌是一种少见的胰腺恶性肿瘤,易出现神经、脉管的侵犯和肝脏、淋巴结以及远处的转移。具有侵袭性强、恶性程度大、预后差的特点。可通过定期体检、早期发现、早期进行手术并辅助以放化疗的综合治疗来提高疗效。

Objective To explore the clinical features,pathological characteristics,therapies and prognosis of pancreatic adenosquamous carcinoma patients to improve the understanding and treatment efficacy.Methods The clinical data of 2 pancreatic adenosquamous carcinoma patients treated at Department of Hepatobiliary Surgery of Yijishan Hospital in March 2014 and January 2015 were retrospectively analyzed and discussed with literature review.Results There were 1 male patient and 1 female patient of pancreatic adenosquamous carcinoma.Preoperative imaging examination results showed pancreatic occupying lesions located in the head of pancreas.One patient was hospitalized for upper abdominal pain and the other one was in hospital because of jaundice and dark urine.Serum tumor marker CA199 was increased before surgery in both patients.After relevant examinations,one patient underwent total laparoscopic pancreaticoduodenectomy while the other patient underwent laparoscopic assisted pancreatoduodenectomy.Chemotherapy was performed after surgery.Surgical pathology indicated that both of them suffered from pancreatic adenosquamous carcinoma.Postoperative follow-up of the patients were effective.One case died because of tumor recurrence 22 months after surgery and the other case died of multiple liver metastases ten months after surgery.Conclusion Pancreatic adenosquamous carcinoma,a rare form of pancreatic malignancy,was prone to neural and vascular invasion,and liver,lymph gland and distant metastasis,which was characterized with strong invasion,high degree of malignancy and poor prognosis.Therefore,efficacy could be improved by comprehensive therapy,including regular physical examination,early detection,and early surgery assisted with chemoradiotherapy.