多种肿瘤成分并存的胰腺及壶腹部恶性肿瘤生存分析  

Clinical and prognostic analysis of malignancies with multi-tumor factors in pancreas and periampullary region

作　　者：牛耿明[1] 纪元[1] 王单松[1] 靳大勇[1] 楼文晖[1] 

机构地区：[1]复旦大学附属中山医院普外科胰腺组,上海200032

出　　处：《中华肝胆外科杂志》2009年第3期196-198,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨多种肿瘤成分并存的胰腺及壶腹部恶性肿瘤的生物学特点及临床治疗方法。方法回顾性分析复旦大学附属中山医院2005年1月至2007年5月收治的18例多种肿瘤成分并存的胰腺及壶腹部恶性肿瘤的临床特点、影像学改变、病理特征、治疗过程及随访资料并结合文献讨论。结果该组18例病人，男11例，女7例；平均年龄62．4±11．7（36～80）岁。其中碰撞癌11例，即肿瘤成分间尤混合及移行状态；其余7例为混合癌，即肿瘤成分相互掺杂。肿瘤分别位于胰腺、胆总管下端及十二指肠壶腹部14例，其余4例则分别位于胰头＋胆囊（双碰撞癌）、胰头＋胆总管下端、十二指肠壶腹部＋胆总管下端以及十二指肠乳头＋十二指肠近幽门部。组织学类型以导管内乳头状黏液腺癌（intraductal papillary mucinous carcinoma，IPMC）合并导管腺痛/神经内分泌癌以及导管腺癌合并其它壶腹部少见类型恶性肿瘤为主。pT分期以2、3期多见，而病理分期则以早、中期为主。行胰十二指肠切除术15例，胰体尾＋脾切除术2例，全胰切除术1例。所有病人均无围手术期死亡，术后均未出现严重并发症。随访18例，术后均辅以化疗或加中医治疗，其中10例死亡，多死于肿瘤复发或肝脏转移。全部病人中位生存期仅13．2个月，较同期实施的胰腺导管腺癌根治性切除者（中位生存期27个月）、胰腺及壶腹部恶性肿瘤姑息件手术者（中位生存期20．9个月）更差。结论多种成分并存的胰腺及壶腹部恶性肿瘤多发生存胰头及胆总管下端，以导管内乳头状黏液腺癌或导管腺癌合并其它少见类型恶性肿瘤为主，pT分期以2、3期多见，而病理分期则以早、中期为主，预后极差。Objective To investigate the biological features and treatment of malignancies with muhi-tumor factors in the pancreas and periampullary region. Methods A retrospective clinical analysis was conducted on J8 cases of the malignancies admitted to our hospital during 2005.1- 2007.5. The clinical features, imaging findings, therapeutic and pathological data were analyzed. Meanwhile, the prognosis of this kind of malignancies was compared with that of adenoductal cancer undergoing radical pancreateetomy and that of periampullary carcinoma receiving palliative operation. Results The ma lignancies were found in 11 men and 7 women with a mean age of 62.4±11.7 years. Tumors were located in the pancreas, the lower end of common bile duct and the ampullary part of duodenum in 14 cases, ampullary duodenum and common bile duct in 1, pancreas and gallbladder in 1, pancreas and common bile duct in 1 and papillary duodenum and beginning of duodenum in 1. Fifteen of them received pancreaticoduodenectomy （PD）, 2 resection of distal pancreas plus splenectomy and the others total pancreatectomy. Ten patients died of tumor recurrence or liver metastasis several months after operation. For the 8 patients who survived, the longest survival time was 18 months. The median sur- vival time for those patients was only 13.2 months, which was significantly shorter than 27 months for the adenoduetal cancer receiving PI） and 20.9 months for the periampullary carcinoma undergoing palliative therapy. Conclusion The malignancies with muhi-tumor factors in the pancreas and per/ampul lary region are located mainly in the head of pancreas and the lower part of common bile duct, among which combination of IPMC or adenoductal careinoma with other rare types of malignancies were the most common histotypes. The prognosis of this kind of carcinoma is poor and needs further research.

关 键 词：胰腺肿瘤 多种肿瘤成分并存 治疗方法 影像学检查 

分 类 号：R686[医药卫生—骨科学]