壶腹周围癌631例的临床病理表现和外科疗效

目的　研究各种类型壶腹周围癌之间的区别与联系。方法　回顾性分析1980年1月至2003年12月收治的631例壶腹周围癌患者的临床表现、病理行为和术后生存情况。结果　胰头癌(352例)、胆总管癌(42例)、壶腹癌(189例)、十二指肠癌(48例)等壶腹周围癌存在以下差异:(1)平均症状持续时间(周)分别为11. 9±1. 3、5. 8±0 .9、6. 3±0. 6、18 .3±4 .0 (F=6 .18,P<0. 01);(2)血清总胆红素水平(μmol/L)分别为225±10、345±35、235±13、50±13 (χ2 =68 .49,P<0 01 );(3)肿瘤平均直径(cm)分别为6 .0±2. 2、3 0±1 .3、3 .0±1 .9、4. 8±3. 9 (χ2 =255. 7,P<0 01 ); ( 4 )腺癌分化程度(χ2 =9 .70,P<0 .05); (5)肿瘤切除后的T分期(χ2 =11. 68,P<0 .01 )和淋巴结状态(χ2 =8 33,P<0. 05); (6)无法切除肿瘤的十二指肠侵犯(χ2 =10. 76,P<0 .01 )、胆总管侵犯(χ2 =15 16,P<0 .01)、壶腹周围组织侵犯(χ2 =22. 49,P<0. 01)、大血管侵犯(χ2 =51 25,P<0 .01); (7)手术切除率13% (46例)、50% (21例)、74% (139例)、56% (27例) (χ2 =205 6,P<0. 01); (8)术后中位生存期(月)分别为6.0±0 3、13. 0±1 .2、22. 0±1 6、13 .0±2 .5 (χ2 =173. 47,P<0 .01 )。结论　不同类型壶腹周围癌的临床表现、病理学行为、手术切

Clinico-pathological characteristics of surgical effect on periampullary cancers: report of 631 cases

OBJECTIVE: To analyze the differences and relationships among periampullary cancers. METHODS: A retrospective study was accomplished on the clinical manifestation, pathological behavior and postoperative survival of 631 patients with periampullary cancer hospitalized from Jan 1980 to Dec 2003. RESULTS: The characteristics of different periampullary cancers, in the order of carcinoma of head of pancreas (n = 352), carcinoma of common bile duct (n = 42), carcinoma of Vater's ampulla (n = 189), and duodenal cancer (n = 48) were as follows: (1) the mean duration of symptoms were 11.9 +/- 1.3, 5.8 +/- 0.9, 6.3 +/- 0.6, and 18.3 +/- 4.0 weeks (F = 6.18, P < 0.01); (2) the serum total bilirubin was 225 +/- 10, 345 +/- 35, 235 +/- 13, and 50 +/- 13 micromol/L(chi(2) = 68.49, P < 0.01); (3) the mean tumor size was 6.0 +/- 2.2, 3.0 +/- 1.3, 3.0 +/- 1.9, and 4.8 +/- 3.9 cm respectively (chi(2) = 255.7, P < 0.01); (4) adenocarcinoma accounted for 88%. Distant metastasis occurred in 98 cases, mostly to liver, abdominal cavity, and omentum. Local invasion mainly occurred in duodenum (chi(2) = 10.76, P < 0.01), common bile duct (chi(2) = 15.16, P < 0.01), and periampullary tissues (chi(2) = 22.49, P < 0.01), and great vessels (chi(2) = 51.25, P < 0.01). (5) the T staging (chi(2) = 11.68, P < 0.01) and lymph node status (chi(2) = 8.33, P < 0.05) of the removed tumor specimens were different among different kinds of carcinomas; (6) local invasion of duodenum (chi(2) = 10.76, P < 0.01), common bile duct (chi(2) = 15.16, P < 0.001), periampullary tissues (chi(2) = 22.49, P < 0.01), and great vessel (chi(2) = 51.25, P < 0.01) occurred in unresectable carcinomas; (7) the resection rates were 13% (n = 46), 50% (n = 21), 74% (n = 139), and 56% (n = 27) respectively (chi(2) = 205.6, P < 0.01); (8) the postoperative median survival periods were 6.0 +/- 0.3, 13.0 +/- 1.2, 22.0 +/- 1.6, and 13.0 +/- 2.5 months respectively (chi(2) = 173.47, P < 0.01). CONCLUSION: Different tumor has its predominant clinical manifestation, pathological character, the probability of resection, and postoperative median survival. The prognosis after surgical treatment may be decided by biological behavior of tumor itself.