中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2014年
9期
658-661
,共4页
宋彬%刘晓彬%马洪运%纪伟平%邵成浩%胡先贵%金钢
宋彬%劉曉彬%馬洪運%紀偉平%邵成浩%鬍先貴%金鋼
송빈%류효빈%마홍운%기위평%소성호%호선귀%금강
胰腺肿瘤%诊断%治疗%腺鳞癌
胰腺腫瘤%診斷%治療%腺鱗癌
이선종류%진단%치료%선린암
Pancreatic neoplasms%Diagnosis%Therapy%Adenosquamous carcinoma
目的 探讨胰腺腺鳞癌的病例特点及诊治方法.方法 收集2003年12月至2011年10月第二军医大学附属长海医院胰腺外科收治的80例胰腺腺鳞癌患者的临床资料,男性61例,女性19例,年龄28 ～ 81岁,平均60岁.其中首发症状为腹胀不适46例(57.5％)、腰背部痛6例(7.5％)、腹部胀痛伴腰背痛4例(5.0％)、腹部胀痛伴黄疸15例(18.8％)、无痛性黄疸5例(6.3％)、体重明显减轻3例(3.8％)、无症状体检发现1例(1.3％).所有患者术前均通过超声、增强CT或MRI证实为胰腺占位.其中肿瘤位于胰头及钩突者43例,位于胰体者15例,位于胰尾者22例.术后24个月内经门诊定期复诊或每3个月电话随访患者健康状况.结果 80例患者中,接受胰十二指肠切除术19例、保留幽门的胰十二指肠切除术19例、全胰切除术1例、姑息性手术4例.术中出血量50～3 500 ml,术中及术后输血量0～4000 ml.胰十二指肠切除术手术时间90～260 min,胰体尾脾切除术手术时间60 ～ 150 min.术后病理检查结果显示,肿瘤平均最大径(4.9±2.2)cm,35例伴周围淋巴结转移,35例伴胃、十二指肠等周围脏器侵犯,68例侵犯周围神经.术后发生并发症18例,包括腹腔内出血、胰漏、胃排空障碍、切口脂肪液化或感染、胸腔积液、腹腔积液和神经性腹泻.术后48例患者获得有效随访,其中术后16例患者接受化疗,8例患者接受放疗.获得随访的患者均死亡,术后中位生存时间6个月(0.1～23.0个月).结论 胰腺腺鳞癌是一种较少见的胰腺恶性肿瘤,患者大部分伴周围神经侵犯,该病预后差,目前主要治疗手段为手术治疗及放化疗.
目的 探討胰腺腺鱗癌的病例特點及診治方法.方法 收集2003年12月至2011年10月第二軍醫大學附屬長海醫院胰腺外科收治的80例胰腺腺鱗癌患者的臨床資料,男性61例,女性19例,年齡28 ～ 81歲,平均60歲.其中首髮癥狀為腹脹不適46例(57.5％)、腰揹部痛6例(7.5％)、腹部脹痛伴腰揹痛4例(5.0％)、腹部脹痛伴黃疸15例(18.8％)、無痛性黃疸5例(6.3％)、體重明顯減輕3例(3.8％)、無癥狀體檢髮現1例(1.3％).所有患者術前均通過超聲、增彊CT或MRI證實為胰腺佔位.其中腫瘤位于胰頭及鉤突者43例,位于胰體者15例,位于胰尾者22例.術後24箇月內經門診定期複診或每3箇月電話隨訪患者健康狀況.結果 80例患者中,接受胰十二指腸切除術19例、保留幽門的胰十二指腸切除術19例、全胰切除術1例、姑息性手術4例.術中齣血量50～3 500 ml,術中及術後輸血量0～4000 ml.胰十二指腸切除術手術時間90～260 min,胰體尾脾切除術手術時間60 ～ 150 min.術後病理檢查結果顯示,腫瘤平均最大徑(4.9±2.2)cm,35例伴週圍淋巴結轉移,35例伴胃、十二指腸等週圍髒器侵犯,68例侵犯週圍神經.術後髮生併髮癥18例,包括腹腔內齣血、胰漏、胃排空障礙、切口脂肪液化或感染、胸腔積液、腹腔積液和神經性腹瀉.術後48例患者穫得有效隨訪,其中術後16例患者接受化療,8例患者接受放療.穫得隨訪的患者均死亡,術後中位生存時間6箇月(0.1～23.0箇月).結論 胰腺腺鱗癌是一種較少見的胰腺噁性腫瘤,患者大部分伴週圍神經侵犯,該病預後差,目前主要治療手段為手術治療及放化療.
목적 탐토이선선린암적병례특점급진치방법.방법 수집2003년12월지2011년10월제이군의대학부속장해의원이선외과수치적80례이선선린암환자적림상자료,남성61례,녀성19례,년령28 ～ 81세,평균60세.기중수발증상위복창불괄46례(57.5％)、요배부통6례(7.5％)、복부창통반요배통4례(5.0％)、복부창통반황달15례(18.8％)、무통성황달5례(6.3％)、체중명현감경3례(3.8％)、무증상체검발현1례(1.3％).소유환자술전균통과초성、증강CT혹MRI증실위이선점위.기중종류위우이두급구돌자43례,위우이체자15례,위우이미자22례.술후24개월내경문진정기복진혹매3개월전화수방환자건강상황.결과 80례환자중,접수이십이지장절제술19례、보류유문적이십이지장절제술19례、전이절제술1례、고식성수술4례.술중출혈량50～3 500 ml,술중급술후수혈량0～4000 ml.이십이지장절제술수술시간90～260 min,이체미비절제술수술시간60 ～ 150 min.술후병리검사결과현시,종류평균최대경(4.9±2.2)cm,35례반주위림파결전이,35례반위、십이지장등주위장기침범,68례침범주위신경.술후발생병발증18례,포괄복강내출혈、이루、위배공장애、절구지방액화혹감염、흉강적액、복강적액화신경성복사.술후48례환자획득유효수방,기중술후16례환자접수화료,8례환자접수방료.획득수방적환자균사망,술후중위생존시간6개월(0.1～23.0개월).결론 이선선린암시일충교소견적이선악성종류,환자대부분반주위신경침범,해병예후차,목전주요치료수단위수술치료급방화료.
Objective To raise the awareness of adenosquamous carcinoma of pancreas and discuss the treatment of it.Methods Clinical data of 80 cases of pancreas adenosquamous carcinoma patients in the Department of Pancreas Surgery of Changhai Hospital of Second Military Medical University from December 2003 to October 2011 were analyzed.The diagnose and treatment methods were discussed.There were 61 male cases and 19 female cases who aged from 28 to 81 years,with an average age of 60 years.The primary symptoms included 46 cases (57.5％) of abdominal malaise,6 cases (7.5％) of low back pain,4 cases(5.0％) of abdominal swelling pain with low back pain,15 cases(18.8％) of abdominal swelling pain with jaundice,5 cases (6.3 ％) of painless jaundice,3 cases (3.8％) of significantly decreased body-weight and 1 case(1.3％) of no symptom.All the patients had been identified as pancreas tumor suffers by ultrasound,enhanced CT scan or MRI.Totally there were 43 cases of head/unciform process tumors,15 cases of pancreas body tumors and 22 pancreas tail cases.Health situation of all cases were follow-up observed in the outpatient department or telephoned every 3 months till 24 months after the surgery.Results Among the 80 patients,19 patients underwent pancreaticoduodenectomy (PD),19 patients received pylorus-preserving PD,with 4 cases of palliative resection and 1 case of total pancreatectomy.The volume of bleeding during the surgery varied from 50 to 3 500 ml with a blood transfusion volume varied from 0 to 4 000 ml.Consumed time for PD procedures was 90 to 260 min with 60 to 150 min for body and(or) tail resection with or without lienectomy.The mean diameter of tumor was (4.9 ± 2.2) cm.Pathological tests showed 35 cases of positive lymph nodes,adjacent organ invasion happened in 35 patients,however,nerve invasion were found in 68 cases.Eighteen cases occurred postoperative complications,including bleeding,pancreatic fistula,gastric emptying,incision fat liquefaction and infection,pleural effusion,ascites and nervous diarrhea.There were only 48 effective follow-up patients,with a loss ratio of follow-up by 40.0％,reasons for the loss includes change of contact information,refuse or unable to provide useful information by the relatives of the patients.Sixteen patients received chemotherapy,and 8 patients received radiotherapy after operation.All patients were dead in the effective follow-ups.The postoperative median survival time was 6 months (0.1 to 23.0 months).Conclusions Adenosquamous carcinoma of pancreas is a rare kind of malignant tumor,nerve invasion can be found in almost all the cases.Patients with adenosquamous carcinoma of pancreas have an unfavorable prognosis.The principle treatments are surgery,radiotherapy and chemotherapy.
