胰体尾恶性肿瘤与胰头癌外科治疗效果比较

目的研究胰体尾恶性肿瘤的临床病理特点和外科治疗的效果。方法回顾性分析1980年1月至2003年12月我院收治的106例胰体尾恶性肿瘤患者的临床病理表现和术后生存时间,并与同期451例胰头癌患者进行比较。结果胰体尾恶性肿瘤和胰头癌相比,有以下特点：（1）疼痛多见（0．74：0．41,x^2=37．035,P〈0．01）而黄疸少见（0．04：0．75,x^2=155．509,P〈0．01）;（2）总胆红素水平（F=105．341,P〈0．01）、麸丙酮酸转氨胯（SGPT）（F=89．351,P〈0．01）低而白蛋白水平高（F=26．642,P〈0．01）;（3）CEA阳性率较高（0．40：0．24,x^2=6．148,P=0．046）、CA199阳性率较低（0．57：0．86,x^2=24．132,P〈0．01）;（4）同时性肝脏（0．30：0．17,x^2=9．003,P〈0．01）及总体远处转移率（0．38：0．20,x^2=14．266,P〈0．01）显著高于胰头癌;（5）无转移胰体尾恶性肿瘤和胰头癌切除术后的中位生存期均为15个月,无差异（x^2=0．29,P=0．59）;有转移的胰体尾恶性肿瘤切除术后中位生存期（7个月）和未切除的胰体尾恶性肿瘤（6个月）（x^2=0．22,P=0．64）及未切除的胰头癌（5个月）（x^2=0．91,P=0．34）比较无显著差异。无转移时胰体尾肿瘤切除术后的生存显著优于有转移时切除术后（x^2=21．63,P〈0．01）。结论与胰头癌相比胰体尾恶性肿瘤更容易发生远处转移、特别是肝转移。出现远处转移后的胰体尾切除不能延长生存期。远处转移的防治是改善胰体尾恶性肿瘤预后的关键。

Surgical effect of malignant tumor of body and tail of the pancreas: compare with pancreatic head cancer

OBJECTIVES: To investigate the clinical-pathological characteristics and surgical prognosis of malignant tumor of pancreatic body and tail. METHODS: A retrospective study was accomplished on clinical manifestation, pathological behavior and postoperative survival in 106 patients with malignant tumor of pancreatic body and tail in single institution from Jan 1980 to Dec 2003, and compared these with 451 patients with malignant pancreatic cancer. RESULTS: There were significant differences in the following parameters (malignant tumor of the body and tail vs those of the head) between the two tumors: (1) the complaints of pain (0.74:41, chi(2) = 37.035, P < 0.01) and jaundice (0.04:0.75, chi(2) = 155.509, P < 0.01); (2) serum SGPT [(27.33 +/- 3.98) U/L: (118.60 +/- 4.59) U/L, F = 89.351, P < 0.01], total bilirubin [(1.46 +/- 0.46) mg/dl: (14.11 +/- 0.60) mg/dl, F = 105.341, P < 0.01] and albumin [(4.20 +/- 0.45) g/L: (3.91 +/- 0.03) g/L, F = 26.642, P < 0.001]; (3) CEA (0.40:0.24, chi(2) = 6.148, P = 0.046) and CA-19-9 positive rate (0.57:0.86, chi(2) = 24.132, P < 0.01); (4) the concomitant total metastasis (0.38:0.20, chi(2) = 14.266, P < 0.01), including liver metastasis (0.30:0.17, chi(2) = 9.003, P < 0.01). Postoperative median survival, resection of non-metastatic pancreatic body and tail cancer was longer than resection of metastatic disease significantly (15 vs 7 months,chi(2) = 21.63, P < 0.01), which the latter was the same as those who didn't remove (6 months,chi(2) = 0.22, P = 0.64). CONCLUSIONS: The predominant problem is distant metastasis (especially liver metastasis) in the malignant tumor of the body and tail of the pancreas in comparison with pancreatic head cancer. Resection of the body and tail could not increase postoperative survival if metastasis exists. The major way to improve the prognosis is to prevent and manage the distant metastasis.