Clinical Analysis Of 63 Cases Of Periampullary Carcinoma With Whipple Therapy

BackgroundPeriampullary carcinoma is a kind of cancer with high malignancy and strong invasion, including cancer of head of pancreas, lower part of common bile duct, duodenal papilla and Vater ampulla. With the development of the medical diagnostic technology, improved understanding and surgical operation of periampullary carcinoma,, its early detection and postoperative survival rate is increased.ObjectiveTo summarize the clinical and pathological features of periampullary carcinoma, analyze its related factors which influence the prognosis.MethodsTo summarize 63 cases with periampullary carcinoma from January 2008 to January 2011 in Shandong Provincial Hospital, all cases were accepted radical pancreaticoduodenectom (Whipple therapy), analyze the correlation of clinical, pathological features and prognosis with SPSS software.ResultMales 44 (69.8%), females 19 (30.2%), the ratio is 2.32. Main manifestation including jaundice 52 (82.5%), abdominal pain 23 (36.5%), anorexia22 (34.9%); cases with hypertension 13(20.6%), diabetes 8(12.7%), coronary heart disease(CHD) 5 (7.9%); cases with postoperative complication including biliary fistula 25 (39.7%), pancreatic fistula 6 (9.5%), bleeding 3 (4.8%); pancreatic carcinoma (HP) 26 (41.2%), cholangjiocarcinoma (BD) 15 (23.8%), cancer of Vater ampulla (V) 11 (17.5%), cancer of duodenal papilla (DP) (17.5%); cases with lymph node metastasis 17 (27.0%), nerves invasion 15 (23.8%); vessels invasion 14 (22.2%), pericarcinoma invasion 44 (69.8%). To analyze the relevance of age, gender, clinical manifestation, postoperative complication, tumor site, tumor size, lymph node metastasis, nerves invasion, vessels invasion, pericarcinoma invasion, tissue differentiations, pathological types, tumor makers, biochemical indicators with SPSS. Then we evaluate the independent risk factors affecting using COX. The result shows that tumor site, tumor size, lymph node metastasis, nerves invasion, vessels invasion and pericarcinoma invasion correlated with the prognosis of cases (P<0.05), other indicators are not significantly correlated with the prognosis(P>0.05). Cox analysis shows tumor site and nerves invasion are the independent risk factors, pancreatic carcinoma(HD) has the most poor prognosis (median survival time is 21.36 months).ConclusionPeriampullary carcinoma mainly present with jaundice and abdominal pain, older male people have higher morbidity than younger and female people. Tumor site, tumor size, lymph node metastasis, nerves invasion, vessels invasion, pericarcinoma and invasion correlated with the prognosis, and age, gender, clinical manifestation, postoperative complications, biochemical indicators, tumor makers, pathological types, tissue differentiations, operation time, operation bleeding, smoking history is not significantly correlated with prognosis. Tumor site and nerves invasion are the independent risk factors which can affect the carcinoma prognosis.