胰头癌可切除性的术前综合评估

目的探讨术前综合评估在判断胰头癌可切除性中的价值。方法收集2006年1月至2006年11月经解放军总医院手术治疗的56例胰头癌，按手术切除方式分为根治性手术组与姑息性手术组，并对两组病例的临床病理特点、实验室检查、CT影像特征进行回顾性分析。结果56例胰头癌根治性切除20例（36．7％），姑息性切除组36例（64．3％），姑息性切除的原因主要是血管侵犯（22例）、远处转移（8例）、侵犯周围器官或腹膜后组织并固定（6例）。两组病例中，根治性切除组的背痛及腹痛发生率较低，临床TNM分期多为I～Ⅱ（P〈0．05）；术前CT影像提示瘤体较小，血管侵犯率低（P〈0．01）。而黄疽、体重下降、肿瘤病理类型、分化程度、胆红素水平、血清肿瘤标记物、胆管及主胰管扩张的差异无统计学意义（P〉0．05）。结论术前综合评估是判断胰腺癌可切除性的有效手段。

PREOPERATIVE COMPREHENSIVE EVALUATION OF RESECTABILITY OF PANCREATIC HEAD CARCINOMA

Objective To investigate the value of preoperative comprehensive evaluation in resectability of pancreatic head carcinoma. Methods 56 cases with pancreatic head carcinoma admitted and treated with surgery in our hospital from January 2006 to November 2006 were collected. According to the different surgery condition, clinical data of those patients were divided into two groups （radical resection/palliative resection） and analyzed retrospectively. Results 20 of 56 cases （36.7 % ） underwent radical resection and the other 36 （64. 3 % ）received palliative resections. The reason for palliative resection was vascular encroachment （22 cases）, distant metabasis（8 cases）, infiltration to surrounding organs or retroperitoneum and fixed（6 cases）. Compared to palliative resection group, the incidence rate of back pain and abdominal pain in radical resection group was lower and TMN tumor staging was at stage of I - II （ P 〈 0. 05）. Preoperative CT image showed that tumor size was smaller and incidence rate of vascular encroachment was lower in radical resection group （ P 〈 0. 01 ）. However, differences in jaundice, weight lost, tumor pathology type, cell differentiation, biliru- bin, tumor marker, cholangiectasis and pancreatic duct dilation had no statistically significant between the two groups （P 〉 0. 05 ）. Conclusions Preoperative comprehensive evaluation is an effective method in the judgement of resectability of pancreatic head carci- noma.