十二指肠乳头腺癌行胰十二指肠切除术194例预后因素分析  

Prognostic analysis of clinical pathological characteristics of duodenal papilla adenocarcinoma treated by pancreatoduodenectomy: A 194 cases report

作　　者：周洋 成伟[1] 尹新民[1] 周磊[1] 刘雅玲 左芝 彭创[1] 蒋波[1] ZHOU Yang, CHENG Wei, YIN Xin-min, et al(Department of Hepatobiliary Surgery, Hunan Provincial People ＇s Hospital, Changsha 410005, China)

机构地区：[1]湖南省人民医院肝胆微创外科,湖南长沙410005

出　　处：《中国实用外科杂志》2018年第10期1183-1186,1190,共5页Chinese Journal of Practical Surgery

基　　金：湖南省自然科学基金(No.2017JJ2159)

摘　　要：目的分析行胰十二指肠切除术的十二指肠乳头腺癌病人的临床病理学特征与预后关系。方法回顾性分析2011年1月至2016年12月湖南省人民医院肝胆外科行胰十二指肠切除术且病理学诊断为十二指肠乳头腺癌的194例病人的临床资料,随访病人术后生存情况,分析影响病人生存的因素。结果 194例病人中,高、中、低分化腺癌分别为6例(3.1%)、112例(57.7%)、76例(39.2%),淋巴结转移61例(31.4%),神经浸润7例(3.6%)。随着分化程度降低,淋巴结转移发生率显著增高(P=0.000),神经浸润差异无统计学意义(P=0.585)。中位生存时间为37个月,1、3、5年存活率分别为81.6%、50.1%、36.9%。单因素分析发现,术前血清CA19-9、癌胚抗原(CEA)、肿瘤T分期、分化程度、淋巴结转移、神经浸润是影响病人生存的危险因素;多因素分析发现,淋巴结转移是影响十二指肠乳头腺癌根治性切除病人预后的独立危险因素(RR=1.953,95%CI 1.043~3.654,P=0.036)。结论胰十二指肠切除术是十二指肠乳头腺癌首选的治疗方式,淋巴结转移是影响其预后的独立危险因素。Objective To investigate the relationship between the pathological characteristics and prognosis of duodenal papillary adenocarcinoma. Methods The clinical and pathological data of 194 patients undergoing pancreatoduodeneetomy and afterwards pathological diagnosed to duodenal papillary adenocarcinoma from January 2011 to December 2016 at the Department of Hepatobiliary Surgery of Hunan Provincial People＇s Hospital was retrospectively analyzed. The postoperative survival condition of the patients was followed-up and factors affecting patient survival was analyzed. Results Postoperative pathological diagnosis showed 6 cases with well-differentiated adenoearcinoma （3.1%）, 112 cases with moderate-ly-differentiated adenocareinoma （57.7%）, and 76 cases with poorly-differentiated adenocarcinoma （39.2%）. With the decrease of differentiation, a significant increase on lymph node metastasis rate （P= 0,000） and no significant difference on nerve infiltration rate （P=0.585） were observed. Median survival of the entire cohort was 37 months. Overall actuarial survival at 1, 3, and 5 years was 81.6%,50.1%,36.9%, respectively. Univariate analysis suggested that preoperative serum carbohydrate antigen 19-9 （CA19-9）, carcinoembryonic antigen （CEA）, T stage, differentiation, lymph node metastasis, and nerve infiltration remarkably influenced the postoperative survival. On multivariate analysis, positive lymph node state was an independent risk factor for postoperative survival （RR=1.953, 95% CI 1.043-3.654, P=0.036）. Conclusion The pancreatoduodenectomy is the preferred treatment for duodenal papillary adenocarcinoma. The lymph node metastasis is independent risk factor for postoperative survival.

关 键 词：十二指肠乳头腺癌 临床病理学特征 胰十二指肠切除术 预后 

分 类 号：R6[医药卫生—外科学]