CAJ | 학술논문

目的探讨小胰腺癌的临床特点、诊断方法和预后影响因素.方法回顾性分析接受手术治疗且随访资料完整的89例胰腺癌患者的临床病理资料,其中直径≤2 cm的胰腺癌(14例)为小胰腺癌组,直径>2 cm的胰腺癌(75例)为对照组,总结小胰腺癌的诊断和预后特点.结果 CT和MRI检查对小胰腺癌的检出率分别为66.7%(8/12)和77.8%(7/9).小胰腺癌组有2例肿瘤侵犯胰腺被膜,3例出现腹膜后侵犯,3例出现淋巴结转移.小胰腺癌组患者的3、5年生存率分别为42.8%和31.7%,中位生存时间为56.5个月.对照组患者的3、5年生存率分别为29.7%和22.5%,中位生存时间为22.5个月.对全组89例胰腺癌患者的预后因素进行Cox回归分析的结果显示,胰腺被膜侵犯、淋巴结转移和腹膜后侵犯是影响预后的独立危险因素(均P<0.05),而肿瘤大小不是影响患者预后的独立因素(P>0.05).结论小胰腺癌患者的总体预后较好,CT和MRI检查是诊断小胰腺癌的主要手段,淋巴结转移和局部侵犯是小胰腺癌预后不良的标志.对于小胰腺癌患者,为获得良好的预后应采取积极的根治性手术.
목적 탐토소이선암적림상특점、진단방법 화예후영향인소.방법 회고성분석접수수술치료차수방자료완정적89례이선암환자적림상병리자료,기중직경≤2 cm적이선암(14례)위소이선암조,직경>2 cm적이선암(75례)위대조조,총결소이선암적진단화예후특점.결과 CT화MRI검사대소이선암적검출솔분별위66.7%(8/12)화77.8%(7/9).소이선암조유2례종류침범이선피막,3례출현복막후침범,3례출현림파결전이.소이선암조환자적3、5년생존솔분별위42.8%화31.7%,중위생존시간위56.5개월.대조조환자적3、5년생존솔분별위29.7%화22.5%,중위생존시간위22.5개월.대전조89례이선암환자적예후인소진행Cox회귀분석적결과 현시,이선피막침범、림파결전이화복막후침범시영향예후적독립위험인소(균P<0.05),이종류대소불시영향환자예후적독립인소(P>0.05).결론 소이선암환자적총체예후교호,CT화MRI검사시진단소이선암적주요수단,림파결전이화국부침범시소이선암예후불량적표지.대우소이선암환자,위획득량호적예후응채취적겁적근치성수술.
Objective To investigate the clinicopathological characteristics, diagnostic methods and prognosis of small pancreatic cancer. Methods From May 2000 to January 2007, 89 patients with pancreatic cancer underwent surgery in our hospital. Of those, 14 had a tumor ≤2 cm in diameter (small tumor group), and the other 75 had a tumor > 2 cm in diameter (controlled group). The clinicopathological data of all the cases were retrospectively reviewed and analyzed. Results In the small pancreatic cancer group, CT and MRI detected 66. 7% (8/12) and 77. 8% (7/9) of the tumors, respectively. Serosal infiltration was found in 2 cases, lymph node involvement in 3 cases, and retroperitoneal infiltration in 3 cases. The follow-up duration of this group was 4 - 86 months. The overall 3- and 5-year survival rates were 42.8% and 31.7%, while in the control group, the overall 3- and 5-year survival rates were 29.7% and 22.5%, respectively. The multivariate analysis showed that the lymph node involvement, serosal infiltration and retroperitoneal infiltration were independent risk factors (P < 0.05). However, the tumor size was not shown to be an independent risk factor (OR value = 1.45, P = 0.971). Conclusion CT and MRI are valuable in detecting small pancreatic cancer. Small pancreatic cancers are likely to have a better prognosis when compared with larger ones. Lymph node metastasis and local infiltration are independent predictors of prognosis but not tumor size.