Nakao A, Harada A, Nonami T, Kaneko T, Inoue S, Takagi H
Department of Surgery II, Nagoya University School of Medicine, Japan.
Surgery. 1995 Jan;117(1):50-5. doi: 10.1016/s0039-6060(05)80229-6.
The purpose of the present study was to clarify the indication of aggressive surgery for pancreatic head carcinoma.
Laparatomy was performed in 153 patients with carcinoma, 101 of whom underwent resection of the carcinoma. With histologic examination the degree of carcinoma invasion into the portal vein was classified into grades 0, I, or II according to the depth of invasion by the carcinoma. Macroscopic carcinoma invasion into portal vein was classified into types A, B, C, or D according to preoperative findings on the portal phase of superior mesenteric angiography or intraoperative portography.
Macroscopic findings correlated with the histologic invasion grades. The 1-year survival rate was 39.6% in grade 0, 11.3% in grade I, and 5.5% in grade II cases. The survival rates of patients with type A (p < 0.01), B (p < 0.05), and C invasion (p < 0.01) were higher than those of patients who did not undergo resection; however, no significant difference in the survival rates between patients who did not undergo resection and patients with type D invasion was observed.
For locally advanced carcinoma of the pancreatic head or entire pancreas, patients with type D invasion have no indication of aggressive surgery.
本研究的目的是明确胰头癌根治性手术的指征。
对153例胰腺癌患者实施了剖腹手术，其中101例行癌切除术。通过组织学检查，根据癌浸润门静脉的深度将癌浸润程度分为0级、I级或II级。根据术前肠系膜上动脉造影门静脉期或术中门静脉造影的表现，将肉眼可见的癌浸润门静脉分为A、B、C或D型。
肉眼所见与组织学浸润分级相关。0级患者1年生存率为39.6%，I级为11.3%，II级为5.5%。A（p < 0.01）、B（p < 0.05）和C型浸润（p < 0.01）患者的生存率高于未行切除术的患者；然而，未行切除术的患者与D型浸润患者的生存率之间未观察到显著差异。
对于局部进展期胰头癌或全胰腺癌，D型浸润患者无根治性手术指征。
