Vater壶腹癌行胰十二指肠切除术后复发的危险因素分析

目的探讨影响Vater壶腹癌胰十二指肠切除术后复发的危险因素，进一步指导临床治疗。方法回顾性分析我院1997年1
月~2005年9月间收治的行胰十二指肠切除术的77例Vater壶腹癌患者的临床资料，采用独立样本t检验、χ2检验进行统计学比
较，应用Logistic回归模型进行多因素分析Vater壶腹癌切除术后复发的危险因素。结果30例患者术后出现肿瘤复发和/或转
移，单因素分析表明，肿瘤直径（P=0.008）、肿瘤侵润深度（P=0.003）、淋巴结转移情况（P=0.039）、TNM分期（P=0.027）、肿瘤分化
情况（P=0.019）是影响Vater 壶腹癌患者术后复发的危险因素；多因素回归分析显示肿瘤直径（P=0.032）、肿瘤分化情况（P=
0.027）是有统计学意义的独立预后指标。结论Vater壶腹癌行胰十二指肠切除术后复发方式以远处转移为主；肿瘤直径、肿瘤
分化情况是影响预后的独立相关因素。

Predictors of recurrence after pancreaticoduodenectomy for carcinoma of the ampulla of Vater

Objective To investigate the predictors for recurrence of carcinoma ampulla of Vater following pancreatico-duodenectomy.Methods We reviewed the clinical data of 77 patients with carcinoma of the ampulla of Vater who received surgical intervention with pancreaticoduodenectomy.Independent t-test and χ2 test were used for statistical comparison,and logistic regression was used for multivariate analysis to investigate the predictors for tumor recurrence following pancreaticoduodenectomy.Results The tumor recurred in 30 patients following the surgery.Univariate analysis showed that tumor size(P=0.008),tumor invasion depth(P=0.003),lymph node metastasis status(P=0.039),TNM staging(P=0.027),and grade of cell differentiation(P=0.019) were significant prognostic factors of carcinoma of the ampulla of Vater.Multivariate analysis identified tumor size(P=0.032) and grade of cell differentiation(P=0.027) as independent prognostic factors of the carcinoma.Conclusion Distant failure is the predominant recurrence pattern of carcinoma of the ampulla of Vater after curative resections,and tumor size and grade of cell differentiation are the most important factors influencing the outcome of the patients.