CAJ | 학술논문

胰腺腺鳞癌是一种临床罕见的胰腺外分泌恶性肿瘤,手术治疗是唯一延长患者生存时间和提高生命质量的可能方法.2013年7月绍兴市人民医院收治1例胰腺腺鳞癌伴肉瘤样改变患者.该患者入院前1年腹部CT检查示胰尾部囊性肿块,无任何临床症状.患者左季肋区饱胀不适,CA19-9为3 630 kU/L,CA125为645 kU/L.CT和MRI检查及术中探查见胰尾和脾胃间巨大囊实性肿块,囊性为主,根植于胰尾部,浸润脾胃及周围组织.术后病理学检查诊断为胰腺腺癌伴鳞状上皮分化和肉瘤样改变,胃壁处以浸润性鳞癌为主,脾脏和淋巴结以肉瘤样改变为主伴部分鳞状上皮分化,周围淋巴结转移.虽然手术切除彻底,术后予以注射胸腺肽免疫治疗以及中医药治疗,但是患者术后5个月肿瘤复发,术后8个月因恶病质、恶性贫血死亡.胰腺腺鳞癌患者预后差,及早发现并手术治疗是提高疗效的关键.
이선선린암시일충림상한견적이선외분비악성종류,수술치료시유일연장환자생존시간화제고생명질량적가능방법.2013년7월소흥시인민의원수치1례이선선린암반육류양개변환자.해환자입원전1년복부CT검사시이미부낭성종괴,무임하림상증상.환자좌계륵구포창불괄,CA19-9위3 630 kU/L,CA125위645 kU/L.CT화MRI검사급술중탐사견이미화비위간거대낭실성종괴,낭성위주,근식우이미부,침윤비위급주위조직.술후병이학검사진단위이선선암반린상상피분화화육류양개변,위벽처이침윤성린암위주,비장화림파결이육류양개변위주반부분린상상피분화,주위림파결전이.수연수술절제철저,술후여이주사흉선태면역치료이급중의약치료,단시환자술후5개월종류복발,술후8개월인악병질、악성빈혈사망.이선선린암환자예후차,급조발현병수술치료시제고료효적관건.
Pancreatic adenosquamous carcinoma is a rare exocrine pancreatic cancer,and surgical treatment is the only promising method in survival time extension and life quality enhancement.In July 2013,1 patient with pancreatic adenosquamous carcinoma and sarcomatoid change was admitted to the Shaoxing People's Hospital.A cauda pancreatis cystic nidus was detected by computed tomography 1 year ago,and no any other clinical symptoms were detected.The left upper quadrant of the patient was glutted and unwell,and the levels of CA19-9 and CA125 were 3 630 kU/L and 645 kU/L,respectively.The results of computed tomography and magnetic resonance imaging showed that a huge cystic and solid tumor was located between the cauda pancreatis,the stomach and the spleen;the tumor was mainly cystic and rooted in the tail of the pancreas;the spleen,stomach and surrounding tissues were infiltrated by the tumor.The results of postoperative pathological examination showed that the tumor was pancreatic adenocarcinoma with squamous epithelial differentiation and sarcomatoid change;the invasive squamous carcinoma dominated stomach wall,and the sarcomatoid change dominated spleen and lymph nodes with partial squamous epithelial differentiation and surrounding lymph nodes metastases.Although the surgical resection was complete and the postoperative thymosin injection and traditional Chinese medicine were implemented,tumor recurred at postoperative month 5,and the patient was dead due to cachexia and pernicious anemia at postoperative month 8.The prognosis of patients with pancreatic adenosquamous carcinoma is poor,early detection and surgery are key points for curative effect enhancement.