目的 探讨螺旋CT双期薄层增强扫描对胰头癌可切除性的评估价值。方法 回顾性分析24例经螺旋CT双期薄层增强扫描胰头癌的CT表现，观察肿块对邻近器官或组织侵犯情况，以及有无远处器官和淋巴结转移，据此判断肿块能否切除，并将其结果与手术病理结果相对照。结果 螺旋CT判断胰头癌可切除的敏感性为90.9%，特异性为84.6%，阳性预测值为83.3%，阴性预测值为91.7%，准确性为87.5%。结论 螺旋CT双期薄层增强扫描判断胰头癌可切除性的价值较高，对外科医生选择最佳治疗方案有较大的帮助。
【摘要】目的探讨提高可切除胰头癌疗效和降低手术风险的方法。方法回顾我院1996年1月至2001年12月期间行根治性胰十二指肠切除术治疗的胰头癌病例，对可切除胰头癌患者的术前评估、围手术期治疗和术式选择进行分析。结果外科收治胰头癌271例，行根治性切除术73例，根治切除率为26.9%（73/271），围手术期死亡率为6.8%（5/73）。其中56例行改良扩大的胰十二指肠切除术，1年和3年生存率分别为71.4%和33.9%。结论根治性胰十二指肠切除术是可切除胰头癌惟一可能提供治愈机会的治疗选择。加强术前评估并同时重视围手术期处理，有助于改善预后。
ObjectiveTo investigate the correlation with clinicopathologic factors and prognosis in pancreatic head cancer following radical resection. MethodsThirteen-eight patients with primary pancreatic head cancer admitted into Urumuqi General Hospital of Lanzhou Military Region from January 2000 to December 2007 were treated by radical resection, the clinicopathologic factors were retrospectively analyzed, the SPSS 17.0 analysis software was used to analyze the relation between clinicopathologic factors and prognosis. Results①The follow-up rate was 81.6%(31/38), the 1-and 2-year overall survival was 38.7% and 12.9%, respectively.②Spearman analysis showed that the distant metastasis was significantly correlated with the tumor size(rs=0.421, P=0.008)and TNM stage(rs=0.746, P=0.000); the lymph node metastasis was significantly correlated with TNM stage(rs=0.543, P=0.001)and was not correlated with tumor differentiation degree(rs=0.074, P=0.695), the tumor size was also significantly correlated with TNM stage (rs=0.475, P=0.003).③Univariate Chi-Square test revealed that the gender(P=0.045), tumor size(P=0.004), tumor differentiation degree(P=0.003), TNM stage(P=0.000), distant metastasis(P=0.002), and lymph node metastasis(P=0.001)were correlated with the prognosis of pancreatic head cancer. However, when the interactive effects of those factors were taken into account, TNM stage(P=0.001), differentiation degree(P=0.003), and lymph node metastasis(P=0.007)were selected as the most significant prognostic factors in a multivariate analysis by using the Cox proportional hazard regression model.④The survival rate of patients with low differentiation degree was significantly shorter than that of moderate/high differentiation degree(P=0.003), of patients withⅠ+Ⅱstages was significantly longer than that ofⅢ+Ⅳstages(P=0.000), of patients with distant metastasis or lymph node metastasis was significantly lower than those patients without distant metastasis or lymph node metastasis(P=0.002, P=0.001). ConclusionsThe lymph node metastasis is significantly associated with TNM stage, and is not associated with differentiation degree. The lymph node metastasis, differentiation degree, and TNM stage are related with survival, and they are also independent prognostic factors of pancreatic head cancer.
ObjectiveTo explore the prognostic factors of malignant tumors in ampulla, lower bile duct, head of pancreas, uncinate process, and neck of pancreas after operation.MethodThe recent literatures on malignant tumors in this region at home and abroad were summarized.ResultsThe prognosis of five groups of malignant tumors in ampulla, lower bile duct, head of pancreas, uncinate process, and neck of pancreas was correlated with their origin, growth site, tumor diameter, nerve invasion, vascular invasion, lymphatic metastasis, pathological and histological classification, and cutting edge status. The different location and pathological classification of tumors made the different neurovascular invasion rate, lymphatic metastasis rate, and R0 resection rate.ConclusionsBy summarizing and analyzing the origin, growth site, diameter, nerve invasion, vascular invasion, lymphatic metastasis, pathological and histological classification, and cutting edge status of tumors, we can improve the clinical prediction of tumors in this region, select appropriate surgical methods before operation, and formulate more reasonable adjuvant treatment plan after operation, in order to improve the pertinence of the treatment of tumors in this region, improve the prediction, and finally better serve the clinical work.
【Abstract】 Objective To summarize the experience in radical excision of carcinoma of head of pancreas in order to improve the surgical skills and reduce the occurrence of postoperative complications. Methods The clinical material of 55 patients (ages: 32-72 years; mean age: 56.5 years) with carcinoma of head of pancreas who received radical excision from January 1996 to March 2005 were analyzed retrospectively. All the cases were pathologically verified as ductal adenocarcinoma of head of pancreas. The treatment time following the operations was divided into two phases by year 2002 ( phaseⅠ: 1996-2002; phaseⅡ: 2002-2005). Different surgical treatment groups were fixed and ICU and other measures were implemented during the second phase. Results All the patients, consisting of 31 males and 24 females, underwent consecutive extended resection. The radically curative rates of phaseⅠand phaseⅡ were 25.9%(29/112) and 34.7%(26/75), respectively, and the complication rates were 48.3%（14/29） and 19.2%（5/26）, respectively. A variety of surgical skills would improve the operation, including extended regional lymphadenectomy, resection of involved nerve plexus, combined vessel resection and comprehensive bleeding-control technique and so on. Conclusion The improvement of radically curative effect and the reduction of complication rate depend on the advancement of surgical skills and the further understanding of pathophysiology of carcinoma of head of pancreas.
Objective To evaluate the long-term efficacy of extended and standard surgery for carcinoma of head of pancreas by using meta-analysis. Methods Related articls （1990-2012） were searched in Pubmed， WOS， Embase， WanFang， SinoMed， and CNKI. Study on quality of these literatures were evaluated by using the Jadad score. The patients with pancreatic head carcinoma underwent extended radical resection and standard radical resection were classified to treatment group and control group， respectively. The mortality， morbidity， and survival rates of 1-， 3-， and 5-year after operation in the two groups were evaluated by using meta-analysis. Results A total of 11 studies fitted the selection crit-eria， including 744 patients. Among them 357 cases were in standard radical resection group and 387 cases in the extended radical resection group. The results of meta-analysis showed that： ①The morbidity after operation did not significantly differed between the extended radical resection group and standard radical resection group （OR=1.360， 95% CI=0.990-1.870， P=0.050）. ②The mortality of the two groups did not significantly differed （OR=0.870， 95% CI=0.430-1.760，P=0.700）. ③There were no significant differences in survival rates of 1-， 3-， and 5-year between the two groups （OR=0.880， 95% CI=0.450-1.720， P=0.710；OR=0.940， 95% CI=0.590-1.480，P=0.710；OR=1.000， 95% CI=0.600-1.67， P=1.000）. Conclusion Compared with standard radical resection， extended radical resection can not improve the survival rates of 1-， 3-， and 5-year after operation， and can’t reduce the mortality and morbidity after operation
ObjectiveTo investigate the proportion of peripheral blood CD4+CD25+ regulatory T cells (Tregs) in patients with pancreatic head carcinoma, the dynamic changes of these cells before and after pancreatoduodenectomy were also analyzed. MethodsThe proportions of peripheral blood CD4+CD25+ Tregs in patients with pancreatic head carcinoma and normal individuals were examined by using flow cytometric analysis. The CD4+/CD8+ ratio was also studied before and after operation. ResultsThe patients with pancreatic head carcinoma showed higher ratio of CD4+CD25+ and CD4+CD25high Tregs compared with normal control before operation (Plt;0.05). However, the percentage of these T cells reduced significantly after pancreatoduodenectomy, which was most obviously on the 3rd day after operation (Plt;0.01, Plt;0.05). After operation, CA199 level began to decrease, which was obvious on the fourteen day after operation. This tendency of CD4+CD25high Tregs changes was similar to that of CA199. The patients showed an decreased ratios of CD4+/CD8+ compared with normal controls, which further declined after operation, and reached the lowest point on the seventh day after operation (Plt;0.05). ConclusionsPancreatoduodenectomy may be helpful for the recovery of antitumor immunity. The perioperative period of patients with pancreatic head carcinoma may be a beneficial windowphase for immune intervention and Tregs may be served as target cells.