十二指肠乳头癌行胰十二指肠切除术疗效及预后因素分析

摘要

Objective To evaluate the prognostic factors and therapeutic strategy for carcinoma of duodenal papilla treated by pancreatoduodeneetomy (PD), Methods Clinicopathological data of 52 patients with duodenal papilla carcinoma who undergone PD and finally diagnosed by surgery and histopathology from January 1998 to June 2006 were retrospectively analyzed. This series included 26 males and 26 females, with a median age of 57 years old (range from 32 to 75 years old). Results The median survival time was 19 months, and the overall 1-, 3- and 5-year cumulative survival rate was 73.1%, 34.6% and 26.9%, respectively,The univariate analysis showed that the prognosis treated by PD were associated with maximum diameter of tumor, regional lymphatic metastasis, infiltration of duodenal wall, involvement of pancreas, differentiation of tumor, postoperative complications and postoperative chemotherapy (P <0.05). The multivariate analysis indicated that regional lymphatic metastasis involvement of pancreas and postoperative chemotherapy were independent prognostic factors. Conclusion Multiple factors have effects on the prognosis of carcinoma of duodenal papilla after PD. Regional lymphatic metastasis, involvement of pancreas and postoperative chemotherapy are independent prognostic factors. Moreover, appropriate postoperative chemotherapy can improve survival rate.%目的 探讨十二指肠乳头癌行胰十二指肠切除术(PD)的疗效及影响预后的因素.方法 回顾性分析我院1998年1月至2006年6月期间收治的52例十二指肠乳头癌行PD术患者的临床病理资料.其中男26倒,女26例,年龄32～75岁,中位年龄为57岁.结果 患者中位生存时间为19个月,1、3、5年累计生存率分别为73.1％、34.6％、26.9％.单变量分析显示,肿瘤最大直径、局部淋巴结转移、十二指肠壁浸润、胰腺受累、肿瘤分化程度、术后化疗与十二指肠乳头癌行PD术预后相关.Cox多因素分析显示,局部淋巴结转移、胰腺受累及术后化疗是影响十二指肠乳头癌行PD术长期生存的独立相关因素(P＜0.05),其中术后化疗为保护因素.结论 ①十二指肠乳头癌行PD术长期生存与肿瘤大小、局部淋巴结转移、十二指肠壁浸润、胰腺受累、肿瘤分化程度、术后化疗等多种因素有关.②局部淋巴结转移、胰腺受累及术后化疗是影响十二指肠乳头癌行PD术预后的独立相关因素,术后化疗作为保护因素有助于改善生存率.