胰腺间变癌的诊断和治疗  

Diagnosis and treatment of anaplastic carcinoma of the pancreas

作　　者：许雪峰[1] 楼文晖[1] 纪元 邵叶波[1] 施晨晔[1] 吴文川[1] 靳大勇[1] 

机构地区：[1]复旦大学附属中山医院普通外科、复旦大学普通外科研究所,上海200032 [2]病理科

出　　处：《中华消化外科杂志》2013年第8期561-563,共3页Chinese Journal of Digestive Surgery

基　　金：卫生公益性行业科研专项经费项目（201202007）

摘　　要：目的探讨胰腺间变癌的诊断和治疗。方法回顾性分析1999年1月至2010年6月复旦大学附属中山医院收治的10例胰腺间变癌患者的临床资料。患者术前行CT检查，根据肿瘤部位制订手术方案。术后进行后续放、化疗。采用电话和门诊进行随访，随访时间截至2013年3月。分析患者的临床特点、影像学改变、病理学特征、治疗过程及随访资料。对患者的临床与病理特征分析采用描述性统计，连续性变量以贾±s表示，分类变量以频数和百分率表示。结果10例患者中肿瘤位于胰头5例、胰颈部1例、胰体尾部4例。10例患者中行胰十二指肠切除术2例、胰十二指肠切除＋扩大淋巴结清扫术2例、胰十二指肠切除＋门静脉重建术1例、全胰切除1例、胰体尾＋脾切除术4例。病理检查：瘤体大小为2．0cm×2．0cm×2．0cm～14．0cm×12．0cm×9．0cm。肿瘤呈浸润性生长。5例胰头部肿瘤患者中，4例侵犯十二指肠、胆总管，1例侵犯肠系膜上静脉。门静脉；1例胰体尾肿瘤侵犯脾动脉。8例患者镜下见肿瘤侵犯神经，其中4例有淋巴结转移。免疫组织化学染色检查：10例患者细胞角蛋白7阳性，其中1例波形蛋白阳性。10例患者中，1例失访，2例未接受后续治疗，6例接受吉西他滨化疗，1例行介入治疗。9例随访患者术后生存时间为8～20个月，中位生存时间为12个月，8例患者因肿瘤复发和转移死亡。结论胰腺间变癌是导管腺癌的特殊类型，恶性程度极高。该病确诊依靠病理检查，术前影像学检查结果指导手术方案，术后对放、化疗不敏感。Objective To investigate the diagnosis and treatment of anaplastic carcinoma of the pancreas. Methods The clinical data of 10 patients with anaplastie carcinoma of the pancreas who were admitted to the Zhongshan Hospital from January 1999 to June 2010 were retrospectively analyzed. Computed tomography was carried out preoperatively and surgical plan was designed according to the site of tumors. Chemoradiotherapy was applied postoperatively. Patients were followed up till March 2012 by phone call and out-patient examination. The clinical and imaging features, pathological characteristics, treatment and follow-up data were analyzed. The clini- cal and pathological features were analyzed by descriptive statistics. The continuous data were described as x-＋ s, and categorical data were presented by fi＇equency and precentage. Results The tumors located at the head of the pancreas were observed in 5 patients, tumor located at the neck of the pancreas in 1 patient, and tumors located at the body and tail of the pancreas in 4 patients. Two patients underwent pancreaticoduodeneetomy （ PD ）, 2 underwent PD ＋ extended lymph node dissection, 1 underwent PD ＋ portal vein reconstruction, 1 underwent pancreatectomy, 4 underwent resection of body and tail of pancreas and splenectomy. The size of the tumors ranged from 2.0cm×2.0cm×2.0cm～14.0cm×12.0cm×9.0cm. Duodenal and biliary invasion was observed in 4 patients, superior mesenteric vein-portal vein invasion in 1 patient, splenic artery invasion in 1 patient. Neural invasion was observed in 8 patients, including 4 patients with lymph node metastasis. The results of immunohistoehemical staining showed that 10 patients were with positive expression of eytokeratin 7, and 1 patient was with positive expression of vimentin. Nine patients were followed up, 2 patients did not receive post- operative chemoradiotherapy, 6 received chemotherapy with Gemicitabine and 1 received interventional treatment. The survival time of the 9 patients ranged from 8 to 20 months, and th

关 键 词：胰腺肿瘤 间变癌 诊断 治疗 

分 类 号：R735[医药卫生—肿瘤]