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胰腺腺鳞癌80例临床诊治分析

A clinical series of 80 patients with adenosquamous carcinoma of pancreas

摘要:

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.

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abstracts:

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.

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作者: 宋彬 [1] 刘晓彬 [1] 马洪运 [1] 纪伟平 [1] 邵成浩 [1] 胡先贵 [1] 金钢 [1]
第一作者: 宋彬
期刊: 《中华外科杂志》2014年52卷9期 658-661页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2014.09.008
发布时间: 2014-09-25
基金项目:
上海市自然科学基金资助项目
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