【摘要】：[目的]1、總結(jié)分析壺腹癌的臨床表現(xiàn)、影像學(xué)表現(xiàn)及病理表現(xiàn);2、探討外科治療后影響壺腹癌預(yù)后的影響因素;3、應(yīng)用Meta分析方法,對(duì)Tis-T2期壺腹癌行胰十二指腸切除術(shù)(Pancreaticoduodenectomy,PD)和局部切除術(shù)(Local resection,LR)的治療療效進(jìn)行評(píng)價(jià),從循證醫(yī)學(xué)角度為局部切除治療壺腹癌提供統(tǒng)計(jì)學(xué)依據(jù)。[方法]1.回顧性分析山東省立醫(yī)院2005年至2016年接受外科手術(shù)治療,病理明確為壺腹癌患者的臨床及病歷資料。采用Kaplan-Meier法對(duì)生存資料進(jìn)行分析,并做Log-rank檢驗(yàn)進(jìn)行統(tǒng)計(jì)學(xué)比較。2.檢索 Pubmed、EMBASE、Cochrane library、知網(wǎng)等數(shù)據(jù)庫(kù),搜集關(guān)于 Tis-T2期壺腹癌行PD與LR治療對(duì)比的相關(guān)文獻(xiàn),截止日期到2016年5月。按照Cochrane系統(tǒng)評(píng)價(jià)方法對(duì)文獻(xiàn)數(shù)據(jù)進(jìn)行數(shù)據(jù)提取,并按NOS(Newcastle-Ottawa Scale)量表對(duì)各納入文獻(xiàn)進(jìn)行質(zhì)量評(píng)價(jià)。采用Cochrane協(xié)作網(wǎng)推薦的Revman5.1軟件合并統(tǒng)計(jì)量及異質(zhì)性檢驗(yàn)。[結(jié)果]1、96例壺腹癌患者1、3、5年生存率為82.9%,57.2%,29.6%。術(shù)前B超和CT是最常用的檢查方式,CT較B超有更高的腫瘤檢出率。術(shù)前內(nèi)鏡下活檢準(zhǔn)確率為73.3%。腫瘤直徑與腫瘤侵犯深度有明顯統(tǒng)計(jì)學(xué)關(guān)系(p0.05),單因素分析腫瘤T分期(p=0.042)、腫瘤大小(P=0.035)、原發(fā)腫瘤淋巴結(jié)轉(zhuǎn)移(p=0.000)是影響預(yù)后的相關(guān)因素。淋巴結(jié)轉(zhuǎn)移為影響壺腹癌患者生存的獨(dú)立危險(xiǎn)因素2、Meta分析比較Tis-T2期壺腹癌患者PD與LR兩種手術(shù)方式療效,共納入11個(gè)研究,在各手術(shù)并發(fā)癥方面,LR均要優(yōu)于PD。兩種術(shù)式術(shù)后腫瘤復(fù)發(fā)率(P=0.31,OR=1.42,95%CI(0.73,2.77))及 5 年生存率(P=0.62,OR=0.89,95%CI(0.57,1.39))均無統(tǒng)計(jì)學(xué)差異。[結(jié)論]1、腫瘤直徑與腫瘤侵犯深度有明顯統(tǒng)計(jì)學(xué)關(guān)系(p0.05),通過腫瘤直徑術(shù)前、術(shù)中的判斷,可預(yù)估腫瘤的侵犯深度。2、腫瘤侵犯深度、腫瘤大小、原發(fā)腫瘤淋巴結(jié)轉(zhuǎn)移是影響腫瘤預(yù)后的相關(guān)因素。淋巴結(jié)轉(zhuǎn)移為影響壺腹癌患者生存的獨(dú)立危險(xiǎn)因素。3、Meta分析結(jié)果示,對(duì)于Tis-T2期壺腹癌的治療,LR術(shù)后并發(fā)癥發(fā)生率明顯低于PD;兩種手術(shù)方式術(shù)后腫瘤復(fù)發(fā)率及5年生存率無統(tǒng)計(jì)學(xué)差異。4、對(duì)于Tis-T2期患者,LR相對(duì)于PD,術(shù)后并發(fā)癥少,且不影響預(yù)后,是一種可行的手術(shù)方式。5、符合以下兩條指征的壺腹癌患者在征得患者同意后,可以考慮行壺腹癌局部切除治療:①臨床分期為Tis-T2期,且腫瘤直徑2cm,病理分化好;②術(shù)前術(shù)中檢查無明顯淋巴結(jié)轉(zhuǎn)移。
[Abstract]:[objective] 1. To summarize and analyze the clinical, imaging and pathological features of ampullary carcinoma. 2. To explore the influencing factors of prognosis of ampullary carcinoma after surgical treatment. 3. Meta analysis was used to evaluate the efficacy of pancreatitis (Pancreaticoduodenectomy,PD) and local resection (Local resection,LR) in the treatment of ampullary carcinoma in Tis-T2 stage. From the point of view of evidence-based medicine, it provides statistical basis for local resection in the treatment of ampullary carcinoma. [method] 1. The clinical and medical data of patients with ampullary cancer from 2005 to 2016 in Shandong Provincial Hospital were analyzed retrospectively. the clinical and medical data of patients with ampullary carcinoma were confirmed by pathology. Kaplan-Meier method was used to analyze the survival data, and Log-rank test was used for statistical comparison. 2. The Pubmed,EMBASE,Cochrane library, knowledge network and other databases were searched to collect the literature on the comparison of PD and LR treatment for Tis-T2 stage ampullary cancer. The deadline is from May 2016. According to the Cochrane system evaluation method, the literature data were extracted, and the quality of each included literature was evaluated according to the NOS (Newcastle-Ottawa Scale) scale. The Revman5.1 software proposed by Cochrane Cooperative Network is used to merge statistics and heterogeneity test. [results] 1, the 3-year and 5-year survival rates of 96 patients with ampullary cancer were 82.9%, 57.2% and 29.6%, respectively. Preoperative B-ultrasound and CT are the most commonly used methods. CT has a higher tumor detection rate than B-ultrasound. The accuracy of endoscopic biopsies before operation was 73.3%. There was a significant statistical relationship between tumor diameter and tumor invasion depth (p0.05). Univariate analysis of tumor T stage (p 鈮，

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