[胰十二指肠切除术后胆总管浸润在 Vater 壶腹腺癌中的预后意义]

Wu Tie-cheng, Shao Yong-fu, Shan Yi, Wu Jian-xiong, Zhao Dong-bing, Xu Li-bin, Zhao Ping

Department of Abdominal Surgery, Cancer Hospital (Institute), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

Zhonghua Zhong Liu Za Zhi. 2008 Oct;30(10):775-8.

OBJECTIVE

To investigate the prognostic implication of common bile duct infiltration in the adenocarcinoma of the ampulla of Vater after panreaticoduodenectomy.

METHODS

A retrospective study was conducted on clinical manifestation, pathological behavior and survival data in 102 patients with Vater's ampulla adenocarcinoma, who underwent pancreaticoduodenectomy from Jan 1980 to Dec 2003. The result of patients with the common bile duct infiltration were compared with that of those without.

RESULTS

There were 42 cases in stage I (41.2%), 32 in stage II (31.3%), 27 in stage III (26.5%), and 1 in stage IV (1.0%). As for T stage: 9 cases in stage T1 (8.8%), 40 in T2 (39.2%), 25 in T3 (24.5%), and 28 in T4 (27.5%). As regarding to N stage: 76 cases in stage N0 (74.5%) and 26 in N1 (25.5%). Of these 102 cases, microscopic infiltration in the common bile duct (25.0%) was identified in 26 cases. A significant difference was observed between the patients with bile duct infiltration and those without, in the proportion of pancreatic medullae infiltration: 84.6% (infiltration group) versus 34.2% (non-infiltration group, P < 0.001). Twenty-five cases (24.5%) had recurrence and/or metastases postoperatively, with a median survival of 20 months (range, 2 to 93 months). The overall median survival of the whole group was 46.0 months (2 approximately 192 months), with a significant difference between the common bile duct infiltration group (36 months) and the non-infiltration group (49 months, P = 0.0061). The median non-recurrence survival of the whole group was 43 months (2 approximately 192 months), and a significant difference was observed between the common bile duct infiltration group (35 months) and non-infiltration group (47 months, P = 0.0002).

CONCLUSION

If the adenocarcinoma of the Vater's ampulla infiltrated the common bile duct, the invasion to the pancreatic medulla is likely developed, and usually with a poor non-recurrence and overall survival. Therefore, postoperative chemotherapy/radiotherapy is suggested.

目的

探讨胰十二指肠切除术后胆总管浸润在壶腹周围腺癌中的预后意义。

方法

对1980年1月至2003年12月期间接受胰十二指肠切除术的102例壶腹周围腺癌患者的临床表现、病理行为和生存数据进行回顾性研究。将胆总管浸润患者的结果与未发生浸润的患者进行比较。

结果

I期42例（41.2%），II期32例（31.3%），III期27例（26.5%），IV期1例（1.0%）。T分期：T1期9例（8.8%），T2期40例（39.2%），T3期25例（24.5%），T4期28例（27.5%）。N分期：N0期76例（74.5%），N1期26例（25.5%）。这102例患者中，26例（25.0%）发现胆总管有微小浸润。胆总管浸润患者与未浸润患者在胰腺髓质浸润比例上存在显著差异：浸润组为84.6%，未浸润组为34.2%（P<0.001）。25例（24.5%）患者术后出现复发和/或转移，中位生存期为20个月（范围2至93个月）。全组总体中位生存期为46.0个月（2至192个月），胆总管浸润组（36个月）与未浸润组（49个月）之间存在显著差异（P = 0.0061）。全组中位无复发生存期为43个月（2至192个月），胆总管浸润组（35个月）与未浸润组（47个月）之间存在显著差异（P = 0.0002）。