Nagakawa T, Mori K, Nakano T, Kadoya M, Kobayashi H, Akiyama T, Kayahara M, Ohta T, Ueno K, Higashino Y
Second Department of Surgery, School of Medicine, Kanazawa University, Ishikawa, Japan.
Br J Surg. 1993 May;80(5):619-21. doi: 10.1002/bjs.1800800526.
Carcinoma of the pancreatobiliary system often produces perineural invasion extending to extrabiliary and extrapancreatic sites. A surgical technique has been developed to manage this invasion and has been used since 1974. Serial sections were prepared from 90 resected specimens and examined for perineural involvement of intramural and extramural biliary plexuses as well as the pancreatic nerve plexus. Perineural invasion was seen in 34 of 40 patients with carcinoma of the common bile duct, in ten of 14 with cancer of the gallbladder and in four of 15 with carcinoma of the papilla of Vater. Invasion extended to the extramural biliary or pancreatic nerve plexuses in 24 of 40 patients with carcinoma of the bile duct. Involvement of the intrapancreatic nerves was seen in all 21 patients with carcinoma of the pancreatic head and that of the pancreatic nerve plexus in 17 of 21. Perineural invasion was often found at the most progressive margin of the tumour. The survival rate of patients with perineural invasion was low compared with that of those without such invasion, although survival of patients with perineural invasion tended to be longer after extensive resection. The perineural space should be regarded as an important route for the spread of pancreatic and biliary carcinoma.
胰胆系统癌常发生神经周围浸润，并扩展至胆管外和胰腺外部位。自1974年以来，已开发出一种手术技术来处理这种浸润。从90个切除标本制备连续切片，检查壁内和壁外胆管丛以及胰腺神经丛的神经周围受累情况。在40例胆总管癌患者中，有34例出现神经周围浸润；在14例胆囊癌患者中，有10例出现；在15例 Vater 乳头癌患者中，有4例出现。在40例胆管癌患者中，有24例浸润扩展至壁外胆管或胰腺神经丛。在所有21例胰头癌患者中均可见胰内神经受累，在21例患者中有17例可见胰腺神经丛受累。神经周围浸润常出现在肿瘤最进展的边缘。与无神经周围浸润的患者相比，有神经周围浸润的患者生存率较低，尽管在广泛切除后，有神经周围浸润的患者生存期往往更长。神经周围间隙应被视为胰胆管癌扩散的重要途径。
