Ⅱ期胰腺癌整块血管切除的预后和可行性。
Prognosis and feasibility of en-bloc vascular resection in stage II pancreatic adenocarcinoma.
机构信息
Department of General Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan 333, Taiwan, China.
出版信息
World J Gastroenterol. 2010 Feb 28;16(8):997-1002. doi: 10.3748/wjg.v16.i8.997.
AIM
To establish the prognosis and feasibility of en-bloc vascular resection of stage II pancreatic adenocarcinoma of the head and uncinate process.
METHODS
We retrospectively analyzed 87 patients with stage II pancreatic adenocarcinoma, who were subjected to pancreaticoduodenectomy (PD) and pylorus-preserving PD (PPPD) between 1996 and 2006 in Chang Gung Memorial Hospital, Taiwan. Twelve and 75 patients underwent PD/PPPD with and without resection of portal vein/superior mesenteric vein (PV/SMV), respectively.
RESULTS
The overall 1- and 3-year survival rates of patients undergoing PD/PPPD with and without vascular resection were 50.0% and 16.7%, and 44.4% and 12.2%, respectively. Morbidity and mortality rates in the PV/SMV resection vs non-resection group were 50.0% and 0.0%, and 40.0% and 2.7%, respectively. In multivariate analysis, serum bilirubin, histological differentiation and adjuvant chemotherapy were independent prognostic factors that influenced survival.
CONCLUSION
In stage II adenocarcinoma of the pancreatic head and uncinate process, serum bilirubin, histological differentiation and adjuvant chemotherapy were independent prognostic factors, and en-bloc vascular resection is a feasible option in carefully selected patients.
目的
评估胰头钩突部Ⅱ期腺癌整块血管切除的预后和可行性。
方法
回顾性分析了 1996 年至 2006 年间在台湾长庚纪念医院接受胰十二指肠切除术（PD）和保留幽门的胰十二指肠切除术（PPPD）的 87 例Ⅱ期胰头腺癌患者。12 例和 75 例患者分别接受了伴有和不伴有门静脉/肠系膜上静脉（PV/SMV）切除的 PD/PPPD。
结果
接受 PD/PPPD 伴或不伴血管切除的患者的 1 年和 3 年总生存率分别为 50.0%和 16.7%，以及 44.4%和 12.2%。PV/SMV 切除组与非切除组的并发症发生率和死亡率分别为 50.0%和 0.0%，以及 40.0%和 2.7%。多因素分析显示，血清胆红素、组织学分化和辅助化疗是影响生存的独立预后因素。
结论
在胰头钩突部Ⅱ期腺癌中，血清胆红素、组织学分化和辅助化疗是独立的预后因素，整块血管切除是精心选择的患者的可行选择。
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