189例胰头癌的诊治分析

目的探讨分析胰头癌的诊治经验和影响预后的因素。方法回顾性分析我院1995年9月至2005年8月收治的189例胰头癌的诊治情况,对近5年的94例患者进行随访,采用Cox比例风险模型找出可能影响胰头癌患者预后的独立因素,并对各因素两个水平的生存率进行比较。结果肿瘤直径大于4 cm、肠系膜血管受侵是严重影响胰头癌预后的独立因素。胰十二指肠切除术或扩大胰十二指肠切除术相对危险度（RR）为姑息治疗的0.502倍（P=0.023）。用Cox回归生存率曲线估计的根治手术组的中位生存期约为460 d。结论胰头癌是一种预后很差的消化系统恶性肿瘤,胰十二指肠切除术或扩大胰十二指肠切除术是目前治疗胰头癌的惟一有效手段。提高对高危人群的警惕,有序开展各种影像学（B超、CT及超声内镜等）和血清学检查（CA19-9）,早期发现病变,及时实施根治性切除,是提高患者的生存时间和生活质量的关键。

Clinical analysis of pancreatic head carcinoma in 189 cases

Objective To summarize the clinical experiences for diagnosis and management of pancreatic head carcinoma,and to analyze the factors influencing its prognosis.Methods The data of 189 cases with pancreatic head carcinoma from September 1995 to August 2005 were retrospectively reviewed. Ninety-four cases surgically treated during recent 5 years were followed up.Cox regression was used to screen out risk factors and compare the Cox regression survival curves derived from the two levels of a factor. Results Pancreaticoduodenectomy was the key factor influencing the prognosis of pancreatic head carcinoma.Comparing with palliative treatment,the risk ratio (RR) was 0.502 (P=0.023),and the median survival time after curative resection was 460 days approximately,which was significantly longer than that after palliative treatment,averaging at 240 days.Conclusions Pancreaticoduodenectomy is now the only curative-intent treatment for the pancreatic head carcinoma.Imaging and serologic examination (CA19-9),early diagnosis and curative-intent resection is the key to obtain long postoperative survival and better quality of life.