胰体尾癌的根治切除与外科疗效分析

目的 探讨胰体尾癌R0(根治性)切除率的影响因素和外科疗效.方法 回顾性分析214例胰体尾癌病例的临床病理、手术资料及预后.结果 该组214例胰体尾癌中有120例接受手术治疗,手术治疗组总切除率为59.2%(71/120例),R0率为40.8%(49/120例).与其他治疗方式相比,R0切除病例的肿瘤直径小、淋巴结转移率低及周围脏器浸润率低,且Ⅰ期、Ⅱ期和Ⅲ期病例的根治切除率(分别为100%、100%和87.5%)明显高于ⅣA期(29%)和ⅣB期(0)病例(P＜0.01).该组病例总的1、3及5年生存率分别为14.5%(31/214例)、7.0%(15/214)和2.4%(5/214例),R0切除组1、3及5年生存率分别为53.1%(26/49例)、30.6%(15/49例)和10.2%(5/49),显著好于其他治疗方式病例(9.1%、0及0 vs12.2%、0及0 vs.1.2%、0及0)(P＜0.01).结论 提高胰体尾癌的切除率在于早期诊断,且根治性切除是提高肿瘤疗效的关键.

Radical resection and analysis of surgical outcome for carcinoma of body and tail of pancreas

Objective To explore the radical (RO) resection rate and surgical outcome for the carcinoma of body and tail of the pancreas.Methods The clinical and operative data and follow-up Results of 214 patients with the carcinoma of body and tail of the pancreas were analyzed retrospectively.Results One hundred and twenty of the 214 patients with the carcinoma of body and tail of the pancreas underwent surgical treatment,the overall resection rate was 59.2% (71/120),and the R0 resection rate was 40.8% (49/120).Compared with other treatments,the patients receiving R0 resection had smaller size,lower lymph node involvement and peri-pancrcatic organ involvement.The radical resection rates for TNM stage Ⅰ ,Ⅱ and Ⅲ patients were 100%,100% and 87.5%,respectively,which were significantly higher than those in stage IV A (29% ) and IVB(0% ) (P＜ 0.01 ).Moreover,the overall 1,3 and 5-year survival rates in the total resection of the carcinoma of body and tail of the pancreas were 14.5%(31/214),7.0%(15/214) and 2.4%(5/214),respectively,which were significantly better than those in the palliative resection group (9.1%,0 and 0),bypass operarion and laparotomy group (12.2%,0 and 0) and non-surgical group (1.20%,0 and 0)(P＜0.01).Conclusions The early diagnosis of the carcinoma of body and tail of the pancreas is crucial for increase in radical resection rate.The radical resection plays an important role in the improvement of surgical treatment.