摘要
目的 综合分析和评价临床病理特点和治疗方式对胰腺癌患者预后的影响.方法 选取2004年1月至2007年1月,由贵阳医学院附属医院肝胆外科收治的胰腺癌患者作为本课题研究对象,选择其中临床资料齐全并且获得成功随访的91例患者,对有可能影响预后的临床病理因素（包括临床病理特点和治疗方式）进行单因素Kruskal-Wallis法和多因素Cox比例风险模型的统计学分析处理,用Kaplan-Meier方法计算生存率,评价因素对临床预后的影响.结果 可能影响胰腺癌患者预后的临床病理因素包括：年龄、性别、肿瘤部位、病理类型、胰周侵犯（包括周围血管、淋巴结、邻近脏器）、远处转移（包括肝转移）、临床分期和治疗方式.单因素分析表明：胰周侵犯、远处转移、临床分期、治疗方式与胰腺癌预后密切相关（P＆lt;0.05）;而年龄、性别、肿瘤部位、病理类型与预后关系不密切（P＆gt;0.05）.再对筛选出来的有统计学意义的临床病理因素,应用多因素分析表明：胰周侵犯是影响胰腺癌患者预后的首位独立因素.肿瘤临床分期（TNM）Ⅰ期、Ⅱ期、Ⅲ期、Ⅴ期患者的1年生存率分别为80.65%、74.29%、26.32%、25.00%,5年生存率分别为16.31%、5.71%、0、0.根治手术组（包括胰十二指肠切除术、胰体尾切除术）、姑息手术组（包括单纯胆囊空肠吻合术、胆总管空肠Roux-en-Y吻合术、胆肠吻合加胃肠吻合术、十二指肠镜下胆道内支架植入术）1年生存率分别为77.42%、23.08%,5年生存率分别为9.22%、0.结论 胰周侵犯是影响胰腺癌患者预后的首位独立因素.早期确诊并进行根治性手术切除是提高胰腺癌患者生存率的最有效方法.对不能行根治性手术的胰腺癌患者应根据其个体情况选择不同类型的姑息手术方式治疗.
Objective To evaluate the effects of various clinical factors （including clinicopatho- logic characteristics ＆ treatment modalities） on the prognosis of patients with pancreatic carcinoma. Methods The patients of pancreatic cancer were selected from Department of Hepatobiliary Surgery, Affiliated Hospital, Guiyang Medical College during January 2004 to January 2007. All factors （inclu- ding clinicopathologic characteristics and treatment modalities） were studied by univariate （Kruskab Wallis） and multivariate （Cox＇s model） analyses. Survival rate was calculated by Kaplan-Meier meth- od. Results Factors potentially impacting prognosis included age, gender, tumor location, pathologi- cal type, tumor clinical stage, peripancreatic invasion （organs, major vessels ＆ adjacent lymph nodes）, distant metastasis and treatment modalities. Peripancreatic invasion, distant metastasis, clini- cal stage and treatment were significantly correlated with survival by univariate analysis. However, age, gender, location and pathological type of tumor were not significantly correlated with prognosis. Tumor peripancreatic invasion was identified as the most important prognosis factor by multivariate a- nalysis. For the patients in TNM stage Ⅰ , 1-year survival rate was 80. 65% and it was much higher than that of those in stages Ⅱ , Ⅲ -Ⅳ （74. 29%,26. 32%＆ 25. 00% respectively）. The 1-year sur- vival rates were 77. 42%and 23. 08% for the patients undergoing radical resection and palliative opera-tion. And their 5-year survival rates were 9. 22% and 0. 00% respectively. Conclusions Tumor peripancreatic invasion is the most important prognostic factor by multivariate analysis. The early di- agnosis of pancreatic cancer and radical resection are the most effective measure for improved survival rate. Non-radically resected pancreatic cancer patients should be selected according to their individual circumstances to undergo different types of palliative surgery.
出处
《腹部外科》
2014年第1期26-30,共5页
Journal of Abdominal Surgery
基金
贵州省肝胰疾病研究科技创新人才团队基金资助项目,No.黔科合人才团队[2010]4010
关键词
胰腺肿瘤
预后
病理因素
胰周侵犯
Pancreatic neoplasms
Prognosis
Pathological factors
Tumor peripancreatic inva- sion
