胰腺钩突部癌的临床特征和诊断治疗

目的：总结胰腺钩突癌的临床特征及诊断治疗,以提高对胰腺钩突癌的认识。方法：回顾性分析1998年1月－2000年12月收治的41例胰腺钩突癌患者的临床资料及诊治情况。结果：上腹痛伴腰背部疼痛、体重减轻、黄疸是胰腺钩突癌的主要临床症状。36例根治术无手术死亡,其中行胰十二指肠切除术加区域淋巴结清扫术25例,联合肠系膜上静脉－门静脉或肠系膜上动脉局部切除或节段性切除重建者11例,其中行人造血管置换术2例,腹腔神经丛无水酒精注射加腹腔化疗泵放置加肝活检术1例,胆囊空肠Roux-en-Y吻合术2例,剖腹探查术1例,未手术1例。术后生存期为2．0－44．0个月,中位生存期11．2个月,健在4例,最长者44．0个月,术后1年生存率37．0％,3年生存率3．7％。结论：胰腺钩突癌虽然早期诊断困难、易侵犯周围血管、预后较差,只是与肿瘤解剖位置有关,而非肿瘤侵袭性行为,其有相当高（87．8％）的手术切除率。

Uncinate process carcinoma of the pancreas: clinical features and diagnosis and treatment

Objective To summarize the clinical features and diagnosis and treatment of uncinate process carcinoma of the pancreas. Methods From January 1998 to December 2000, 41 patients of pancreas uncinate process carcinoma were retrospectly analysed. Results Upper abdominal pain accompanied with back pain,weight loss and jaundice were the main symptoms. Thirty six patients were subjected to regional pancreaticoduodenectomy (RP), 11 to SMV PV or SMA lateral wall partial resection or partial vascular resection and reconstruction,of which PV reconstruction with PTEE grafts was performed in 2 patients. Two cholecystojejunostomy Roux en Y. Alcohol injection was made in the nerve plexus of the trunks of both celic axes and the superior mesenteric artery and regional chemotherapy via chemotherapy pump and liver biopsy in one case. Abdominal exploration was perfomed in 1 case and no operation in another. None of the cases died perioperatively. Postoperation survival 2-44 months and was 1 the median survival was 11.2 months. Four patients are still alive, the longest surviving have been 44 months. The 1 year and 3 year survival rate was 37 0% and 3 7%. Conclusions Pancreas uncinate process carcinoma has a tendency to invade adjacent SMV/SMA PV and is difficult to diagnose early. Since those are related to its location and not to its invading behavious, the tumon is highly resecable (87 8%).