胰腺腺鳞癌24例临床诊治分析

目的:探讨胰腺腺鳞癌的临床病理特征及诊治经验。方法:回顾性分析我院2006年12月至2018年11月收治的24例胰腺腺鳞癌患者的临床资料。并进行随访，截止到2019年3月31日，失访2例，失访病人采用截尾数据处理。结果:24例患者中男性16例，女性8例，平均年龄为（60.2±9.2）岁。15例（62.5%）患者因上腹痛、腹胀腹泻就诊，4例（16.7%）患者因皮肤巩膜黄染、皮肤瘙痒就诊，2例（8.3%）患者因腹胀伴腰痛就诊，1例（4.2%）患者因腰背痛就诊，1例（4.2%）患者因黑便乏力就诊，1例（4.2%）患者因体检发现胰腺占位就诊。所有患者术前检查均证实为胰腺占位。超声提示胰腺内见肿物，轮廓不规则，边界欠清晰，肿瘤向周围组织呈蟹足样浸润，内呈低回声不均匀，肿瘤坏死液化呈现无回声区。CT提示胰腺可见不规则低密度灶，边界不清，增强扫描病灶呈弱强化，其强化程度明显低于周围胰腺实质。磁共振提示胰腺可见稍长T1、稍长T2信号肿块，边界模糊，增强扫描弱强化，强化欠均匀。术中明确肿瘤位于胰头及钩突部14例（58.3%），胰体尾部10例（41.7%）。肿瘤长径平均为5.1 cm（2.3~10 cm）。TNM分期:Ⅰb期8例（33.3%），Ⅱa期12例（50.0%），Ⅱb期1例（4.2%），Ⅲ期3例（12.5%）。所有患者均行手术治疗，行胰十二指肠切除术14例，胰体尾、脾切除术10例。术后随访22例，失访2例，平均生存时间为21.3个月（1~58个月），随访截止时有8例患者存活。结论:胰腺腺鳞癌是一种罕见的恶性肿瘤，临床表现缺乏特异性，术前影像学表现提示恶性可能，确诊依赖病理学诊断，其具有嗜神经性，手术后结合化疗、放疗仍是目前主要的治疗手段。

Analysis of clinical diagnosis and treatment of 24 cases of pancreatic adenosquamous carcinoma

Objective:To study the clinicopathological characteristics and treatment experience of pancreatic adenosquamous carcinoma.Methods:The clinical data of 24 pancreatic adenosquamous carcinoma patients admitted to our hospital from December 2006 to November 2018 were retrospectively analyzed.Follow-up was conducted.As of March 31,2019,2 patients were lost to follow-up,and the lost patients were treated with truncated data.Results:Among the 24 patients,16 patients were males and 8 patients were females,with an average age of (60.2±9.2) years old.Fifteen patients (62.5%) visited the clinic due to upper abdominal pain and abdominal distension and diarrhea,four patients (16.7%) due to skin scleral yellow and itchy skin,two patients (8.3%) due to abdominal distension and low back pain,one patient (4.2%) due to low back pain,one patient (4.2%) due to melena and weakness,and one patient (4.2%) due to pancreas space occupying found in physical examination.Preoperative examination confirmed pancreatic mass in all patients.Ultrasonography suggested the presence of mass in the pancreas with irregular contour and unclear boundary,crab-like infiltration to surrounding tissues,uneven hypoecho inside,and anechoic area in necrotic liquefaction of the tumor.CT indicated irregular low-density lesions with unclear boundary in the pancreas,weak enhancement in enhanced scan,and significantly lower intensity than surrounding pancreatic parenchyma.MRI suggested a slightly longer T1 and T2 signal mass with fuzzy boundary,weak enhancement and uneven enhancement on enhanced scan.During the operation,tumors were found in the head of the pancreas and uncinate process in 14 cases (58.3%) and the body and tail of the pancreas in 10 cases (41.7%).The mean length diameter of the tumor was 5.1 cm (2.3~10 cm).TNM stage included 8 cases (33.3%) in stage Ⅰb,12 cases (50.0%) in stage Ⅱa,1 case (4.2%) in stage Ⅱb,and 3 cases (12.5%) in stage Ⅲ.All the patients underwent surgical treatment,including pancreatoduodenectomy in 14 cases,pancreatectomy and splenectomy in 10 cases.Twenty-two cases were followed up after operation.Two cases were lost to follow-up.The average survival time was 21.3 months (1~58 months).At the end of follow-up,8 patients survived.Conclusion:Pancreatic adenosquamous carcinoma is a rare malignant tumor with a lack of specificity in clinical manifestations.Preoperative imaging findings suggest the possibility of malignancy.Diagnosis is dependent on pathological diagnosis,and it is neurotropic.Postoperative chemotherapy and radiotherapy are still the main treatment methods.