摘要目的 分析胰腺腺鳞癌的临床病理特征及术后患者的生存期.方法 回顾性分析2003年至2011年上海长海医院手术治疗并经病理证实的71例胰腺腺鳞癌患者资料.术后进行随访,截止时间为2012年12月31日.失访14例,失访病例按截尾数据处理.采用不同的检验方法对患者术后生存期进行单因素分析.结果 71例患者中男性56例,女性15例,年龄28 ～ 81岁,平均60岁.临床症状:腹痛52例次(73.2％),腹胀13例次(18.3％),腰背部放射痛14例次(19.7％),黄疸17例次(23.9％),恶性呕吐2例次(2.8％),体重下降3例次(4.2％).肿瘤位于胰头36例(50.7％),胰颈1例(1.4％),胰体29例(40.8％),胰尾5例(7.0％)；肿瘤长径2～12 cm,平均4.9 cm；TNM分期:ⅠA期2例(2.8％),ⅠB期1例(1.4％),ⅡA期22例(31.0％),ⅡB期36例(50.7％),Ⅲ期6例(8.5％),Ⅳ期4例(5.6％)；淋巴结转移37例(52.1％).行胰十二指肠切除术31例(43.7％),胰体尾切除或联合脾切除术37例(52.1％),探查活检术3例(4.2％).术后行全身化疗35例(49.3％).71例患者术后生存时间为0.1 ～19个月,平均8.5个月,术后1年生存率为21.1％,随访结束无1例存活.肿瘤TNM分期(以ⅡA期为界)、淋巴结转移、术后全身化疗是影响患者术后生存期的独立因素.结论 胰腺腺鳞癌是一种以腺癌和鳞癌混合组成的恶性肿瘤,具有侵袭性较强的生物学行为,患者预后差.

abstractsObjective To investigate the clinicopathological features and outcome of pancreatic adenosquamous carcinoma (ASC) patients after surgery.Methods The medical records of 71 patients with pancreatic ASC who were treated surgically at Shanghai Changhai Hospital from 2003 to 2011 were retrospectively reviewed.These patients were followed after surgery until December 31 st 2012.Forteen patients were lost during follow up,and they were processed as censored data.The survival was univariately analyzed by using different methods.Results Of the 71 patients,there were 56 male and 15 female,the age ranged from 28 ～ 81 years old (median 60 years old).Symptoms included abdominal pain (52,73.2％),abdominal distension (13,18.3％),radiating back pain (14,19.7％),jaundice (17,23.9％),nausea and vomiting (2,2.8％),weight loss (3,4.2％).Tumors were located at pancreatic head in 36 (50.7％) patients,at tail in5 (7.0％),at neck in 1 (1.4％) and at body in 29 (40.8％).Median tumor size was 4.9cm (ranging from 2 ～ 12 cm).As for TNM staging,there were 2 cases of ⅠA (2.8％),1 case of ⅠB (1.4％),22 cases of ⅡA (31.0％),36 cases of ⅡB (50.7％),6 cases of Ⅲ (8.5％),4 cases of Ⅳ (5.6％).Lymph node metastasis was detected in 37 cases (52.1％). Thirty-one (43.7％) patients underwent pancreaticoduodenectomy,37 (52.1％) patients underwent combined distal pancreatectomy and splenectomy,3patients underwent exploratory laparotomy combined with pancreatic tissue biopsy.Thirty-five (49.3％)patients received postoperative chemotherapy.The median survival of 71 patients was 8.5 months (ranging from 0.1 ～ 19 months).The 1 year survival rate was 21.1％,with none survived.TNM staging (ⅡA as the cutoff),lymph node metastasis and without adjuvant chemotherapy were predicators for post-operative survival.Conclusions Pancreatic adenosquamous carcinoma is characterized by the mixture of adenomatous and squamous cell elements and demonstrates aggressive biological behavior and poor prognosis.