CAJ | 학술논문

目的分析胰腺导管内乳头状黏液性肿瘤患者的临床特征及手术疗效.方法收集1999年1月至2008年12月复旦大学附属中山医院手术切除的76例胰腺导管内乳头状黏液性肿瘤的病史资料,并进行随访,分析其临床特征及手术疗效.结果 76例患者中,男性49例,女性27例;肿瘤位于胰头者63例,胰体尾10例,全胰3例;32例为非浸润性肿瘤(腺瘤16例,交界性肿瘤6例,原位癌10例),44例为浸润癌,两者在发病年龄及黄疸、消瘦、无症状患者、CA199升高等方面差异有统计学意义(P＜0.05);胰十二指肠切除59例,联合门静脉切除重建4例,胰体尾切除6例,局部切除2例,节段性胰腺切除2例,全胰切除3例;总体并发症发生率为28.9%,无手术相关死亡病例;非浸润性及浸润性肿瘤患者5年生存率分别为100%及35%;非浸润性肿瘤患者7例切缘阳性,其中1例术后67个月复发转移;多因素分析显示肿瘤直径及淋巴结状况是影响浸润性癌患者预后的独立因素.结论非浸润性胰腺导管内乳头状黏液性肿瘤手术疗效极佳,而浸润癌患者的预后较差;及早手术是防止病变进展及改善预后的关键;术后必须进行长期随访.
목적 분석이선도관내유두상점액성종류환자적림상특정급수술료효.방법 수집1999년1월지2008년12월복단대학부속중산의원수술절제적76례이선도관내유두상점액성종류적병사자료,병진행수방,분석기림상특정급수술료효.결과 76례환자중,남성49례,녀성27례;종류위우이두자63례,이체미10례,전이3례;32례위비침윤성종류(선류16례,교계성종류6례,원위암10례),44례위침윤암,량자재발병년령급황달、소수、무증상환자、CA199승고등방면차이유통계학의의(P＜0.05);이십이지장절제59례,연합문정맥절제중건4례,이체미절제6례,국부절제2례,절단성이선절제2례,전이절제3례;총체병발증발생솔위28.9%,무수술상관사망병례;비침윤성급침윤성종류환자5년생존솔분별위100%급35%;비침윤성종류환자7례절연양성,기중1례술후67개월복발전이;다인소분석현시종류직경급림파결상황시영향침윤성암환자예후적독립인소.결론 비침윤성이선도관내유두상점액성종류수술료효겁가,이침윤암환자적예후교차;급조수술시방지병변진전급개선예후적관건;술후필수진행장기수방.
Objective To investigate the outcome of intraductual papillary mucious neoplasms (IPMN) of the pancreas after surgical resection. Method Clinical data of 76 patients with intraductal papillary neoplasms of the pancreas undergoing surgical resection at Zhongshan Hospital, Fudan University between January 1999 and December 2008 were retrospectively analyzed. Results Among the 76 patients,49 were male, 37 were female. 32 had noninvasive IPMNs, including adenomas( n = 16), borderline tumors (n =6 ), carcinomas in situ (n = 10 ). 44 had invasive IPMNs. Lesions were present in the head in 63 cases, in the body or tail in 10, in the whole pancreas in 3. There were significant difference in age,jaundice, weight loss, asymptomatic cases and CA199 value between noninvasive and invasive IPMNs.Three patients underwent total pancreatectomy, 59 patients underwent pancreaticoduodenectomy, 4 patients underwent pancreaticoduodenectomy with portal vein resection and reconstruction, six patients underwent distal pancreatectomy, two patients each underwent central pancreatectomy or enucleation. The overall postoperative morbidity rate were 28.9%, there was no operative mortality. Positive pancreatic margin was identified in seven patients of noninvasive neoplasms, among thoee one developed recurrence after 67 months. The five-year survival rate for patients with noninvasive and invasive neolpasms was 100% and 35% ,respectively. Size and lymph node metastasis were significant prognostic factors after surgical resection of the invasive IPMNs. Conclusions Surgical resection provides a favorable outcome for patients with noninvasive IPMNs. In contrast, invasive IPMNs was associated with a poor survival. Early resection is essential for improving survival. Long-term follow-up is necessary for all patients with IPMNs after resection.