CAJ | 학술논문

目的探讨多种肿瘤成分并存的胰腺及壶腹部恶性肿瘤的生物学特点及临床治疗方法.方法回顾性分析复旦大学附属中山医院2005年1月至2007年5月收治的18例多种肿瘤成分并存的胰腺及壶腹部恶性肿瘤的临床特点、影像学改变、病理特征、治疗过程及随访资料并结合文献讨论.结果该组18例病人,男11例,女7例;平均年龄62.4±11.7(36～80)岁.其中碰撞癌11例,即肿瘤成分间无混合及移行状态;其余7例为混合癌,即肿瘤成分相互掺杂.肿瘤分别位于胰腺、胆总管下端及十二指肠壶腹部14例,其余4例则分别位于胰头+胆囊(双碰撞癌)、胰头+胆总管下端、十二指肠壶腹部+胆总管下端以及十二指肠乳头+十二指肠近幽门部.组织学类型以导管内乳头状黏液腺癌(intraductal papillary mucinous carcinoma,IPMC)合并导管腺癌/神经内分泌癌以及导管腺癌合并其它壶腹部少见类型恶性肿瘤为主.pT分期以2、3期多见,而病理分期则以早、中期为主.行胰十二指肠切除术15例,胰体尾+脾切除术2例,全胰切除术1例.所有病人均无围手术期死亡,术后均未出现严重并发症.随访18例,术后均辅以化疗或加中医治疗,其中10例死亡,多死于肿瘤复发或肝脏转移.全部病人中位生存期仅13.2个月,较同期实施的胰腺导管腺癌根治性切除者(中位生存期27个月)、胰腺及壶腹部恶性肿瘤姑息性手术者(中位生存期20.9个月)更差.结论多种成分并存的胰腺及壶腹部恶性肿瘤多发生在胰头及胆总管下端,以导管内乳头状黏液腺癌或导管腺癌合并其它少见类型恶性肿瘤为主,pT分期以2、3期多见,而病理分期则以早、中期为主,预后极差.
목적 탐토다충종류성분병존적이선급호복부악성종류적생물학특점급림상치료방 법.방법 회고성분석복단대학부속중산의원2005년1월지2007년5월수치적18례다충종류성분병존적이선급호복부악성종류적림상특점、영상학개변、병리특정、치료과정급수방자료병결합문헌토론.결과 해조18례병인,남11례,녀7례;평균년령62.4±11.7(36～80)세.기중팽당암11례,즉종류성분간무혼합급이행상태;기여7례위혼합암,즉종류성분상호참잡.종류분별위우이선、담총관하단급십이지장호복부14례,기여4례칙분별위우이두+담낭(쌍팽당암)、이두+담총관하단、십이지장호복부+담총관하단이급십이지장유두+십이지장근유문부.조직학류형이도관내유두상점액선암(intraductal papillary mucinous carcinoma,IPMC)합병도관선암/신경내분비암이급도관선암합병기타호복부소견류형악성종류위주.pT분기이2、3기다견,이병리분기칙이조、중기위주.행이십이지장절제술15례,이체미+비절제술2례,전이절제술1례.소유병인균무위수술기사망,술후균미출현엄중병발증.수방18례,술후균보이화료혹가중의치료,기중10례사망,다사우종류복발혹간장전이.전부병인중위생존기부13.2개월,교동기실시적이선도관선암근치성절제자(중위생존기27개월)、이선급호복부악성종류고식성수술자(중위생존기20.9개월)경차.결론 다충성분병존적이선급호복부악성종류다발생재이두급담총관하단,이도관내유두상점액선암혹도관선암합병기타소견류형악성종류위주,pT분기이2、3기다견,이병리분기칙이조、중기위주,예후겁차.
Objective To investigate the biological features and treatment of malignancies with multi-tumor factors in the pancreas and periampullary region. Methods A retrospective clinical analy-sis was conducted on 18 cases of the malignancies admitted to our hospital during 2005.1-2007.5. The clinical features, imaging findings, therapeutic and pathological data were analyzed. Meanwhile, the prognosis of this kind of malignancies was compared with that of adenoductal cancer undergoing radical pancreateetomy and that of periampullary carcinoma receiving palliative operation. Results The ma-lignancies were found in 11 men and 7 women with a mean age of 62.4±11.7 years. Tumors were lo-cated in the pancreas,the lower end of common bile duct and the ampullary part of duodenum in 14 ca-ses, ampullary duodenum and common bile duct in 1, pancreas and gallbladder in 1, pancreas and common bile duct in 1 and papillary duodenum and beginning of duodenum in 1. Fifteen of them re-ceived pancreaticoduodeneetomy (PD), 2 resection of distal pancreas plus splenectomy and the others total pancreatectomy. Ten patients died of tumor recurrence or liver metastasis several months after operation. For the 8 patients who survived, the longest survival time was 18 months. The median sur-vival time for those patients was only 13.2 months, which was significantly shorter than 27 months for the adenoductal cancer receiving PD and 20.9 months for the periampullary carcinoma undergoing pal-liative therapy. Conclusion The malignancies with multi-tumor factors in the pancreas and periampul-lary region are located mainly in the head of pancreas and the lower part of common bile duet, among which combination of IPMC or adenoductal carcinoma with other rare types of malignancies were the most common histotypes. The prognosis of this kind of carcinoma is poor and needs further research.