影响胰头、壶腹部癌患者胰十二指肠切除术后生存的因素

目的分析影响胰头癌、壶腹部癌行胰十二指肠切除术的患者生存期的因素。方法收集1990年1月至2005年6月因胰头癌、壶腹部癌行胰十二指肠切除术的95例患者,有完整随访资料的68例纳入分析。观察的影响因素包括性别,年龄,术前黄疸、GPT、贫血,临床分期,原发肿瘤大小,淋巴结转移,住院期间输血量。Kaplan-Meier法计算累计生存率,单因素分析采用Logrank法,多因素分析采用COX回归模型。结果胰头癌1年、2年、3年生存率分别为37%,12%,12%;壶腹部癌1年、2年、3年生存率分别为60%,38%,31%。单因素分析提示,胰头癌患者的临床分期、肿瘤大小、淋巴结转移及输血量与预后有关(P<0.05);壶腹部癌患者的各观察指标与预后的关系无统计学意义。多因素分析提示输血是胰头癌的独立预后因素;壶腹部癌患者无明确的影响预后的独立因素。结论输血是影响胰头癌预后的独立因素,加强围手术期处理有助改善胰头癌患者的预后。

Survival analysis for patients undergoing Whipple procedure for pancreatic or periampullary toumor.

Objective To investigate the independent prognosis factors for patients underwent Whipple procedure for pancreatic or periampullary cancer.Methods From January 1990 to June 2005,a total of 68 patients underwent pancreaticoduodenectomy(PD),who had complete follow-up data were enrolled.Possible prognostic factors including gender,age,preoperative serum bilirubin,GPT,anemia,TNM staging,size of primary tumor,status of lymph node metastasis,amount of blood transfusion.Survival analysis was performed by Kaplan-Meier curve,univariate analysis was calculated by Log rank method,multivariate analysis was calculated by COX regression model.Results The 1,2 and 3 year survival is 37%,12%,12% respectively for pancreatic head carcinoma,and 60%,38%,31% respectively for periampullary cancer.Univariate prognosis factors for pancreatic head cancer included tumor size,status of lymph node metastasis,blood transfusion and clinical staging.The blood transfusion in pancreatic head carcinoma patients was independent factor influencing survival in the multivariate analysis.Conclusions Blood transfusion was independent prognosis factors for patients of pancreatic head carcinoma after PD.Enhanced peri-operative management will improve the survival for patients with pancreatic head carcinoma after PD.