中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2013年
8期
564-568
,共5页
胰腺肿瘤%外科手术%预后
胰腺腫瘤%外科手術%預後
이선종류%외과수술%예후
Pancreatic neoplasms%Surgical procedure,operative%Prognosis
目的 探讨影响胰体尾癌患者预后的相关因素.方法 回顾性分析1998年1月至2008年12月天津医科大学附属肿瘤医院收治的64例行根治性切除术的胰体尾癌患者的临床资料.患者术前均行腹部超声、CT检查及肿瘤标志物检测了解疾病情况,术前未接受新辅助化疗,采用根治性手术方案,术后进行化疗、生物治疗和放射治疗.收集患者的性别、年龄、腰背疼痛、肿瘤部位、肿瘤最大直径、分化程度、手术方式、淋巴结转移、淋巴结转移率、胰腺内神经浸润、胰腺外神经浸润、胰腺被膜浸润、脾动脉浸润、脾静脉浸润、腹膜后软组织浸润、小静脉浸润、TNM分期等指标.采用Kaplan-Meier法绘制生存曲线,生存情况分析采用Log-rank检验,单因素分析采用x2检验,采用COX风险模型进行多因素预后分析.结果 64例患者均接受Ro切除,平均清扫淋巴结数目为15枚(12～22枚).64例患者中,术后发生胰液漏5例、胃排空障碍3例、腹腔感染1例、下肢深静脉血栓形成1例,无围手术期死亡.64例患者均为导管腺癌或囊腺癌,其中高分化9例、中分化35例、低分化20例；TNM Ⅰ A期4例、ⅠB期9例、ⅡA期17例、ⅡB期34例.44例患者死于肿瘤复发或转移,其中26例为局部复发、18例为远处转移.患者1、3、5年生存率分别为42.2％、17.2％、15.6％,中位生存时间为19.0个月.单因素分析结果表明:腰背疼痛、肿瘤最大直径、分化程度、淋巴结转移、淋巴结转移率、胰腺外神经浸润、脾动脉浸润和TNM分期是影响患者预后的因素(x2=10.658,8.371,18.910,6.605,28.382,14.571,19.476,32.155,P＜ 0.05)；多因素分析结果表明:肿瘤的分化程度、淋巴结转移率、胰腺外神经浸润、脾动脉浸润、TNM分期是影响患者预后的独立危险因素(RR=2.509,2.107,6.692,5.109,4.784,P＜0.05).结论 分化程度、淋巴结转移率、胰腺外神经浸润、脾动脉浸润、TNM分期是影响胰体尾癌患者预后的危险因素.
目的 探討影響胰體尾癌患者預後的相關因素.方法 迴顧性分析1998年1月至2008年12月天津醫科大學附屬腫瘤醫院收治的64例行根治性切除術的胰體尾癌患者的臨床資料.患者術前均行腹部超聲、CT檢查及腫瘤標誌物檢測瞭解疾病情況,術前未接受新輔助化療,採用根治性手術方案,術後進行化療、生物治療和放射治療.收集患者的性彆、年齡、腰揹疼痛、腫瘤部位、腫瘤最大直徑、分化程度、手術方式、淋巴結轉移、淋巴結轉移率、胰腺內神經浸潤、胰腺外神經浸潤、胰腺被膜浸潤、脾動脈浸潤、脾靜脈浸潤、腹膜後軟組織浸潤、小靜脈浸潤、TNM分期等指標.採用Kaplan-Meier法繪製生存麯線,生存情況分析採用Log-rank檢驗,單因素分析採用x2檢驗,採用COX風險模型進行多因素預後分析.結果 64例患者均接受Ro切除,平均清掃淋巴結數目為15枚(12～22枚).64例患者中,術後髮生胰液漏5例、胃排空障礙3例、腹腔感染1例、下肢深靜脈血栓形成1例,無圍手術期死亡.64例患者均為導管腺癌或囊腺癌,其中高分化9例、中分化35例、低分化20例；TNM Ⅰ A期4例、ⅠB期9例、ⅡA期17例、ⅡB期34例.44例患者死于腫瘤複髮或轉移,其中26例為跼部複髮、18例為遠處轉移.患者1、3、5年生存率分彆為42.2％、17.2％、15.6％,中位生存時間為19.0箇月.單因素分析結果錶明:腰揹疼痛、腫瘤最大直徑、分化程度、淋巴結轉移、淋巴結轉移率、胰腺外神經浸潤、脾動脈浸潤和TNM分期是影響患者預後的因素(x2=10.658,8.371,18.910,6.605,28.382,14.571,19.476,32.155,P＜ 0.05)；多因素分析結果錶明:腫瘤的分化程度、淋巴結轉移率、胰腺外神經浸潤、脾動脈浸潤、TNM分期是影響患者預後的獨立危險因素(RR=2.509,2.107,6.692,5.109,4.784,P＜0.05).結論 分化程度、淋巴結轉移率、胰腺外神經浸潤、脾動脈浸潤、TNM分期是影響胰體尾癌患者預後的危險因素.
목적 탐토영향이체미암환자예후적상관인소.방법 회고성분석1998년1월지2008년12월천진의과대학부속종류의원수치적64례행근치성절제술적이체미암환자적림상자료.환자술전균행복부초성、CT검사급종류표지물검측료해질병정황,술전미접수신보조화료,채용근치성수술방안,술후진행화료、생물치료화방사치료.수집환자적성별、년령、요배동통、종류부위、종류최대직경、분화정도、수술방식、림파결전이、림파결전이솔、이선내신경침윤、이선외신경침윤、이선피막침윤、비동맥침윤、비정맥침윤、복막후연조직침윤、소정맥침윤、TNM분기등지표.채용Kaplan-Meier법회제생존곡선,생존정황분석채용Log-rank검험,단인소분석채용x2검험,채용COX풍험모형진행다인소예후분석.결과 64례환자균접수Ro절제,평균청소림파결수목위15매(12～22매).64례환자중,술후발생이액루5례、위배공장애3례、복강감염1례、하지심정맥혈전형성1례,무위수술기사망.64례환자균위도관선암혹낭선암,기중고분화9례、중분화35례、저분화20례；TNM Ⅰ A기4례、ⅠB기9례、ⅡA기17례、ⅡB기34례.44례환자사우종류복발혹전이,기중26례위국부복발、18례위원처전이.환자1、3、5년생존솔분별위42.2％、17.2％、15.6％,중위생존시간위19.0개월.단인소분석결과표명:요배동통、종류최대직경、분화정도、림파결전이、림파결전이솔、이선외신경침윤、비동맥침윤화TNM분기시영향환자예후적인소(x2=10.658,8.371,18.910,6.605,28.382,14.571,19.476,32.155,P＜ 0.05)；다인소분석결과표명:종류적분화정도、림파결전이솔、이선외신경침윤、비동맥침윤、TNM분기시영향환자예후적독립위험인소(RR=2.509,2.107,6.692,5.109,4.784,P＜0.05).결론 분화정도、림파결전이솔、이선외신경침윤、비동맥침윤、TNM분기시영향이체미암환자예후적위험인소.
Objective To investigate the clinical and pathological prognostic factors of the carcinoma of the body and tail of the pancreas.Methods The clinical data of 64 patients with the carcinoma of the body and tail of the pancreas who received radical resection at the Cancer Hospital of Tianjin Medical University from January 1998 to December 2008 were retrospectively analyzed.Abdominal ultrasound,computed tomography and tumor markers detection were carried out preoperatively to learn the condition of the patients.No patient received neoadjuvant therapy before operation,and chemotherapy,biotherapy and radiotherapy were applied to all the patients after radical resection.Indicators including the gender,age,onset of back pain,site,diameter and differentiation of tumors,operative procedure,lymph node metastasis,metastatic rate of lymph nodes,extra-and intra-pancreatic neural invasion,splenic artery invasion,splenic vein invasion,retroperitoneal soft tissue infiltration,venulae infiltration and TNM staging were collected.The survival curve was drawn by Kaplan-Meier method,and the survival was analyzed by Log-rank test.Univariate and multivariate analysis were carried out by chi-square test and COX proportional hazards model,respectively.Results All patients received R0 resection,and the mean number of lymph node resected was 15 (range,12-22).There were 5 patients with pancreatic leakage,3 with delayed gastric emptying,1 with peritoneal infection,and 1 with deep venous thrombosis,no perioperative mortality was detected.All the 64 patients were with ductal adenocarcinoma and cystadenocarcinoma,and 9 patients were with high differentiated tumor,35 with moderate differentiated tumor and 20 with low differentiated tumor.There were 4 patients with tumor in the TNM IA stage,9 in the TNM IB stage,17 in the TNM Ⅱ A stage and 34 in the TNM Ⅱ B stage.Twenty-six patients died of tumor local recurrence and 18 died of tumor distal metastasis.The 1-,3-,5-year survival rates were 42.2％,17.2％ and 15.6％,respectively,and the median survival time was 19.0 months.The result of univariate analysis showed that back pain,maximum tumor diameter,differentiation,lymph node metastasis,metastatic rate of lymph nodes,extra-pancreatic neural invasion,splenic artery invasion and TNM staging were factors affecting prognosis (x2=10.658,8.371,18.910,6.605,28.382,14.571,19.476,32.155,P ＜0.05).The result of multivariate analysis showed that tumor differentiation,metastatic rate of lymph nodes,extra-pancreatic neural invasion,splenic artery invasion,TNM staging were the independent factors affecting prognosis (RR =2.509,2.107,6.692,5.109,4.784,P ＜ 0.05).Conclusion Tumor differentiation,metastatic rate of lymph nodes,extra-pancreatic neural invasion,splenic artery invasion and TNM staging are the risk factors affecting the prognosis of carcinoma of the body and tail of the pancreas.
