Vater壶腹癌是壶腹周围恶性肿瘤中第二常见的疾

病,有资料表明在所有壶腹周围恶性肿瘤手术切除病例中,该病所占比例约为12.
7%~32.
2%[1-2].
目前认为胰十二指肠切除术是其主要的根治性手术方式.
随着诊断技术、手术技巧的提高,其根治性切除的比率已达到76.
5%~88.
0%,而手术死亡率也降至6个月,平均随访时Vater壶腹癌行胰十二指肠切除术后复发的危险因素分析陈继业,蔡守旺,董家鸿解放军总医院肝胆外科,北京100853PredictorsofrecurrenceafterpancreaticoduodenectomyforcarcinomaoftheampullaofVaterCHENJiye,CAIShouwang,DONGJiahongDepartmentofHepatobiliarySurgery,GeneralHospitalofPLA,Beijing100853,China摘要:目的探讨影响Vater壶腹癌胰十二指肠切除术后复发的危险因素,进一步指导临床治疗.
方法回顾性分析我院1997年1月~2005年9月间收治的行胰十二指肠切除术的77例Vater壶腹癌患者的临床资料,采用独立样本t检验、χ2检验进行统计学比较,应用Logistic回归模型进行多因素分析Vater壶腹癌切除术后复发的危险因素.
结果30例患者术后出现肿瘤复发和/或转移,单因素分析表明,肿瘤直径(P=0.
008)、肿瘤侵润深度(P=0.
003)、淋巴结转移情况(P=0.
039)、TNM分期(P=0.
027)、肿瘤分化情况(P=0.
019)是影响Vater壶腹癌患者术后复发的危险因素;多因素回归分析显示肿瘤直径(P=0.
032)、肿瘤分化情况(P=0.
027)是有统计学意义的独立预后指标.
结论Vater壶腹癌行胰十二指肠切除术后复发方式以远处转移为主;肿瘤直径、肿瘤分化情况是影响预后的独立相关因素.
关键词:Vater壶腹癌;胰十二指肠切除术;复发;危险因素中图分类号:R574.
51文献标志码:A文章编号:1673-4254(2012)09-01242-03doi:10.
3969/j.
issn.
1673-4254.
2012.
09.
005http://www.
cnki.
net/kcms/detail/44.
1627.
R.
20120910.
0902.
003.
htmlAbstract:ObjectiveToinvestigatethepredictorsforrecurrenceofcarcinomaampullaofVaterfollowingpancreatico-duodenectomy.
MethodsWereviewedtheclinicaldataof77patientswithcarcinomaoftheampullaofVaterwhoreceivedsurgicalinterventionwithpancreaticoduodenectomy.
Independentt-testandχ2testwereusedforstatisticalcomparison,andlogisticregressionwasusedformultivariateanalysistoinvestigatethepredictorsfortumorrecurrencefollowingpancreaticoduodenectomy.
ResultsThetumorrecurredin30patientsfollowingthesurgery.
Univariateanalysisshowedthattumorsize(P=0.
008),tumorinvasiondepth(P=0.
003),lymphnodemetastasisstatus(P=0.
039),TNMstaging(P=0.
027),andgradeofcelldifferentiation(P=0.
019)weresignificantprognosticfactorsofcarcinomaoftheampullaofVater.
Multivariateanalysisidentifiedtumorsize(P=0.
032)andgradeofcelldifferentiation(P=0.
027)asindependentprognosticfactorsofthecarcinoma.
ConclusionDistantfailureisthepredominantrecurrencepatternofcarcinomaoftheampullaofVateraftercurativeresections,andtumorsizeandgradeofcelldifferentiationarethemostimportantfactorsinfluencingtheoutcomeofthepatients.
Keywords:carcinomaoftheampullaofVater;pancreaticoduodenectomy;recurrence;riskfactors临床研究收稿日期:2012-06-23基金项目:国家科技部支撑计划项目(2012BAI06B01)SupportedbyNationalPlanforScienceandTechnologyResearch(2012BAI06B01).
作者简介:陈继业,博士,主治医师,E-mail:chenjiye@gmail.
com通讯作者:董家鸿,博士,主任医师,教授,博士导师,E-mail:dongjh301@163.
com.
cn南方医科大学学报(JSouthMedUniv)2012;32(9)··1242间为33.
6月.
所有病例术后3个月进行常规血清学、超声、CT检查,此后每年均进行常规复查.
1.
2统计学处理建立临床病例资料数据库,将上述7项观察指标进行量化后输入计算机进行分析.
采用SPSS16.
0forWindows分析软件进行统计学处理.
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