不同部位胰腺癌胰十二指肠切除术后预后分析  

A comparative study on the prognosis of carcinoma of the head,uncinate process and neck of the pancreas after pancreatoduodenectomy

作　　者：冉东辉 耿诚[1] 娄子彦 饶林彬 阿提古·阿不都外力 徐新建[1] Ran Donghui;Geng Cheng;Lou Ziyan;Rao Linbin;Atigu Abuduwaili;Xu Xinjian(Department of Pancreatic Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院胰腺外科,乌鲁木齐830054

出　　处：《中华普通外科杂志》2020年第5期357-361,共5页Chinese Journal of General Surgery

摘　　要：目的探讨不同部位胰腺癌胰十二指肠切除术后的预后影响因素.方法回顾性分析新疆医科大学第一附属医院71例胰十二指肠切除术后患者的临床资料及术后随访数据;采用寿命表法计算壶腹周围癌1、2、3年存活率及中位生存时间,用Kaplan-Meier方法比较肿瘤患者的生存情况,COX比例风险模型进行三组肿瘤单因素及多因素生存分析.结果本组胰腺癌患者中,钩突癌及胰颈癌较胰头癌更多血管侵犯,淋巴结转移率高,R0切除率低(均P<0.05);多因素COX分析提示血管侵犯(P=0.018)、淋巴结转移(P=0.001)、肿瘤生长部位(钩突部P=0.022,胰颈部P=0.000)、R0切除(P=0.000)均是影响患者预后的独立危险因素.胰头癌1年复发率:43.8%,3年生存率:28.1%,中位生存期:20.0个月(95%CI15.565~24.435);钩突癌1年复发率:61.5%,3年生存率:15.4%,中位生存期:14.0个月(95%CI9.003~18.997);胰颈癌1年复发率:69.2%,3年生存率:7.7%,中位生存期为:10.0个月(95%CI5.303~14.697).结论相较于胰头癌,胰腺钩突癌及胰颈癌早期血管侵犯更频繁、手术R0切除率更低、术后局部复发更早,预后更差.Objective To compare the prognosis of pancreatic head cancer,uncinate process cancer and pancreatic neck cancer patients after undergoing pancreatoduodenectomy.Methods The clinical data and follow-up data of 71 pancreatic cancer patients undergoing pancreatoduodenectomy in the First Affiliated Hospital of Xinjiang Medical University were analyzed retrospectively,Kaplan Meier method was used to compare the survival of postoperative patients.COX proportional risk model was used to analyze the survival of three groups of tumor.Results In pancreatic cancer patients,uncinate process cancer and pancreatic neck cancer had more frequent vascular invasion,higher lymph node metastasis rate and lower R0 resection rate than pancreatic head cancer(all P<0.05).Multivariate COX suggested that vascular invasion(P=0.018),lymph node metastasis(P=0.001),tumor site(P=0.022 in uncinate process,P=0.000 in pancreatic neck)and R0 resection(P=0.000)were independent risk factors for prognosis.For pancreatic head cancer the 1-year recurrence rate was 43.8%,3-year survival rate was 28.1%,median survival time was 20.0 months(95%CI15.565-24.435).For uncinate process cancer 1-year recurrence rate was 61.5%,3-year survival rate was 15.4%,median survival time was 14.0 months(95%CI 9.003-18.997)respectively.That was 69.2%,7.7%and 10.0 months(95%CI 5.303-14.697)respectively for pancreatic neck cancer.Conclusion Compared with pancreatic head cancer,uncinate process cancer and pancreatic neck cancer are associated with poorer prognosis because of frequent early vascular invasion,low R0 resection rate and early local recurrence.

关 键 词：胰腺肿瘤 胰十二指肠切除术 预后 

分 类 号：R735.9[医药卫生—肿瘤]