2cm以下的胰头癌的临床特点和外科治疗  

The clinicopathologic features and surgical management of the pancreatic head cancer measuring 2 cm or less in diameter

作　　者：邵成浩[1] 胡先贵[1] 刘瑞[1] 张怡杰[1] 金钢[1] 唐岩[1] 

机构地区：[1]上海第二军医大学附属第一医院普外科,上海200433

出　　处：《外科理论与实践》2005年第3期222-224,共3页Journal of Surgery Concepts & Practice

摘　　要：目的:探讨瘤径<2cm胰头癌的临床病理学特点和外科治疗效果。方法:回顾性整理我院普外科1996年1月至2004年12月收治的48例瘤径<2cm胰头癌的临床资料,并结合随访情况进行分析。结果:本组48例,男29例,女19例,年龄30～83岁。均行胰十二指肠切除术,其中3例合并肠系膜上静脉切除重建术,10例合并区域淋巴结清扫。病理检查:肿瘤直径均2cm以下;其中管状腺癌45例,乳头状腺癌2例,腺鳞癌1例。有淋巴结转移者17例,胰周神经侵犯者25例。随访表明,无淋巴结转移和胰周神经侵犯病例的术后平均生存期(28.7±16.8个月),比淋巴结阳性和(或)有胰周神经侵犯者明显延长。结论:<2cm的胰头癌超过半数以上存在淋巴结转移和神经侵犯,而两者均是影响预后的重要因素。应求扩大淋巴结清扫范围和广泛的腹膜后软组织切除以获得阴性切缘。Objective To investigate the clinicopathological features and surgical management in 48 cases of the pancreatic head cancer measuring 2 cm or less in diameter. Methods A retrospective clinical analysis was made in the 48 cases of small pancreatic head carcinoma admitted from 1996 to 2004. Results The series was constituted by 29 men and 19 women with a mean age of 60.5 years. The tumors were surgically resected in all patients, by pancreacoduodenectomy in 35, by pancreatoduodenectomy combined with resection and reconstruction of the superior mesenteric vein (SMV) in 3, and by pancreatoduodenectomy combined with regional lymph node dissection in 10. Pathology showed 45 cases of tubular adenocarcinoma, 2 cases of papillary adenocarcinoma and 1 case of adenosquamous carcinoma. Lymph node metastasis was found in 17 patients, and perineurol invasion in 25 patients. Follow-up study showed, the mean survival time in patients without lymph node metastasis and perineural invasion was (28.7±16.8)months,which was significantly longer than that in patients with lymph node metastasis and/or perineural invasion. Conclusions Over half of the cases of pancreatic head cancer measuring 2 cm or less in diameter had lymph node metastasis and /or perineurol invasion. Lymph node metastasis and perineurol invasion were two of the most important factors bearing relevance to the prognosis. Radical resection with extensive clearance of peri-pancreatic soft tissue and lymph node curage should be considered as basic steps in the surgical treatment of small pancreatic carcinoma.

关 键 词：胰腺肿瘤 小胰癌 预后 外科手术 

分 类 号：R735.9[医药卫生—肿瘤]