贲门癌胰腺转移的临床特征及治疗方式探讨(附病例报道)

Clinical features and treatment of pancreatic metastasis from cardiac carcinoma(a case report)

目的探讨贲门癌胰腺转移的临床特征及治疗方式。方法回顾性分析西部战区总医院收治的1例贲门癌胰腺转移病例的临床病理资料,对该病例进行的多学科协作(MDT)讨论及诊治结果进行总结。结果该例患者腹部CT显示的胰头实性占位考虑新生物,经MDT讨论决定在排除手术禁忌证后于全麻下行贲门癌根治术加胰十二指肠切除和腹腔淋巴结扩大清扫术,手术顺利,术中出血量约600 mL。术后患者恢复良好,未发生严重并发症,术后第10天出院。术后病理诊断:贲门癌伴胰头种植转移(ⅡA期, T3M0N0);梗阻性黄疸、肝损害;肝内外胆管扩张。术后给予静脉滴注奥沙利铂+替吉奥4个疗程,目前患者一般情况良好,已无瘤生存5个月,复查CA19-9(45.6 U/mL)较术前(449.60 U/mL)显著下降。结论贲门癌胰腺转移临床罕见,需与原发性胰腺癌鉴别,其生存时间短、预后差,目前无公认的标准治疗方案。手术并术后化疗可改善临床症状,延长无进展生存期。

Objective To investigate clinical features and treatment of pancreatic metastasis from cardiac carcinoma. Methods The clinicopathological data of a patient with pancreatic metastasis from cardiac carcinoma in the General Hospital of Western Theater Command were retrospectively analyzed. The results of multi-disciplinary treatment(MDT) of this case were summarized. Results The imaging findings of abdomen CT of this patient were that the solid occupying position of the head of pancreas was considered as a new organism. After discussing by the MDT and exclusing operative contraindications, the radical resection of cardiac cancer with pancreaticoduodenectomy and enlarged intraperitoneal lymph node dissection was performed under the general anesthesia. The operation was smooth and the bleeding was about 600 mL. The patient recovered well after the operation and had no serious complications. The patient was discharged on day 10 after the operation. The results of postoperative pathological diagnosis were the cardiac carcinoma with pancreatic head implantation metastasis(stage Ⅱ A, T3M0N0);obstructive jaundice, liver damage,extrahepatic and extrahepatic biliary dilatation. The patient received the intravenous infusion of the oxaliplatin pluse tigualone for 4 courses. The patient was generally in a good condition and had survived 5 months free tumor. The CA19-9 level was 45.6 U/mL(it was 449.60 U/mL before the operation). Conclusions Pancreatic metastasis from cardiac carcinoma is rare and need to be distinguished from primary pancreatic cancer. Survival time is short and prognosis is poor. Clinical symptoms are improved and survival time is prolonged after operation with postoperative chemotherapy.