Shao Yong-fu, Wu Tie-cheng, Shan Yi, Wu Jian-xiong, Wang Xiang, Zhao Ping
Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Science, Beijing 100021, China.
Zhonghua Yi Xue Za Zhi. 2005 Mar 2;85(8):510-3.
To analyze the differences and relationships among periampullary cancers.
A retrospective study was accomplished on the clinical manifestation, pathological behavior and postoperative survival of 631 patients with periampullary cancer hospitalized from Jan 1980 to Dec 2003.
The characteristics of different periampullary cancers, in the order of carcinoma of head of pancreas (n = 352), carcinoma of common bile duct (n = 42), carcinoma of Vater's ampulla (n = 189), and duodenal cancer (n = 48) were as follows: (1) the mean duration of symptoms were 11.9 +/- 1.3, 5.8 +/- 0.9, 6.3 +/- 0.6, and 18.3 +/- 4.0 weeks (F = 6.18, P < 0.01); (2) the serum total bilirubin was 225 +/- 10, 345 +/- 35, 235 +/- 13, and 50 +/- 13 micromol/L(chi(2) = 68.49, P < 0.01); (3) the mean tumor size was 6.0 +/- 2.2, 3.0 +/- 1.3, 3.0 +/- 1.9, and 4.8 +/- 3.9 cm respectively (chi(2) = 255.7, P < 0.01); (4) adenocarcinoma accounted for 88%. Distant metastasis occurred in 98 cases, mostly to liver, abdominal cavity, and omentum. Local invasion mainly occurred in duodenum (chi(2) = 10.76, P < 0.01), common bile duct (chi(2) = 15.16, P < 0.01), and periampullary tissues (chi(2) = 22.49, P < 0.01), and great vessels (chi(2) = 51.25, P < 0.01). (5) the T staging (chi(2) = 11.68, P < 0.01) and lymph node status (chi(2) = 8.33, P < 0.05) of the removed tumor specimens were different among different kinds of carcinomas; (6) local invasion of duodenum (chi(2) = 10.76, P < 0.01), common bile duct (chi(2) = 15.16, P < 0.001), periampullary tissues (chi(2) = 22.49, P < 0.01), and great vessel (chi(2) = 51.25, P < 0.01) occurred in unresectable carcinomas; (7) the resection rates were 13% (n = 46), 50% (n = 21), 74% (n = 139), and 56% (n = 27) respectively (chi(2) = 205.6, P < 0.01); (8) the postoperative median survival periods were 6.0 +/- 0.3, 13.0 +/- 1.2, 22.0 +/- 1.6, and 13.0 +/- 2.5 months respectively (chi(2) = 173.47, P < 0.01).
Different tumor has its predominant clinical manifestation, pathological character, the probability of resection, and postoperative median survival. The prognosis after surgical treatment may be decided by biological behavior of tumor itself.
分析壶腹周围癌之间的差异及关系。
对1980年1月至2003年12月期间收治的631例壶腹周围癌患者的临床表现、病理行为及术后生存情况进行回顾性研究。
不同类型壶腹周围癌的特征，按胰腺癌（n = 352）、胆总管癌（n = 42）、壶腹癌（n = 189）和十二指肠癌（n = 48）的顺序如下：（1）平均症状持续时间分别为11.9±1.3、5.8±0.9、6.3±0.6和18.3±4.0周（F = 6.18，P < 0.01）；（2）血清总胆红素分别为225±10、345±35、235±13和50±13 μmol/L（χ² = 68.49，P < 0.01）；（3）平均肿瘤大小分别为6.0±2.2、3.0±1.3、3.0±1.9和4.8±3.9 cm（χ² = 255.7，P < 0.01）；（4）腺癌占88%。远处转移98例，主要转移至肝脏、腹腔和大网膜。局部侵犯主要发生在十二指肠（χ² = 10.76，P < 0.01）、胆总管（χ² = 15.16，P < 0.01）、壶腹周围组织（χ² = 22.49，P < 0.01）和大血管（χ² = 51.25，P < 0.01）。（5）不同类型癌切除标本的T分期（χ² = 11.68，P < 0.01）和淋巴结状态（χ² = 8.33，P < 0.05）不同；（6）不可切除癌发生十二指肠（χ² = 10.76，P < 0.01）、胆总管（χ² = 15.16，P < 0.001）、壶腹周围组织（χ² = 22.49，P < 0.01）和大血管（χ² = 51.25，P < 0.01）的局部侵犯；（7）切除率分别为13%（n = 46）、50%（n = 21）、74%（n = 139）和56%（n = 27）（χ² = 205.6，P < 0.01）；（8）术后中位生存期分别为6.0±0.3、13.0±1.2、22.0±1.6和13.0±2.5个月（χ² = 173.47，P < 0.01）。
不同肿瘤具有其主要的临床表现、病理特征、切除概率及术后中位生存期。手术治疗后的预后可能由肿瘤本身的生物学行为决定。
