进展期胰腺癌患者姑息性旁路手术后的预后因素分析
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马湘, Email: maxiang1717@163.com

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Prognostic factors in patients undergoing palliative bypass surgery for advanced pancreatic cancer
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    摘要:

    目的:探讨进展期胰腺癌患者接受姑息性旁路手术后的预后影响因素。
    方法:回顾2005年5月—2013年6月收治的102例接受旁路手术的进展期胰腺癌患者的临床资料,分析患者术后的生存情况与预后影响因素。
    结果:全组患者的中位总生存时间(OS)为8.7个月,生存分析显示,疼痛程度轻微患者中位OS高于疼痛程度严重患者、ASA I/II患者的中位OS高于ASA III级患者、C反应蛋白(CRP)水平正常患者中位OS高于CRP升高患者、无转移患者中位OS高于肝/腹膜转移患者,差异均有统计学意义(均P<0.05)。单因素分析显示,患者的中位OS与疼痛程度、ASA分级、术中失血量、有无肝/腹膜转移、CRP水平、CA19-9水平、白蛋白(ALB)水平有关(均P<0.05);COX回归多因素分析显示,ASA III级、重度疼痛、CRP≥5 mg/L、肝/腹膜转移为影响患者术后生存的独立危险因素(均P<0.05)。
    结论:ASA III级、重度疼痛、高水平CRP及肝、腹膜转移是姑息性治疗的进展期胰腺癌预后不良的指标。

    Abstract:

    Objective: To investigate the factors affecting the prognosis of patients with advanced pancreatic cancer after bypass palliation. Methods: The clinical data of 102 patients with advanced pancreatic cancer admitted from May 2005 to June 2013 who underwent palliative bypass surgery were reviewed. The postoperative survival status and prognostic factors were analyzed. Results: The median overall survival (OS) for the entire group of patients was 8.7 months, and the results of survival analysis showed that the median OS in patients with milder pain was higher than in those with severe pain, in ASA I/II patients was higher than in ASA III ones, in patients with normal C-creative protein (CRP) level was higher than in those with high CRP level, and in patients without metastasis was higher than in those with liver/peritoneal metastases, and all the differences had statistical significance (all P<0.05). Univariate analysis showed that the median OS of the patients was associated with the degree of pain, ASA classification, intraoperative blood loss, whether having liver/peritoneal metastases, and levels of CRP, CA19-9 and albumin (ALB) (all P<0.05). Further, multivariate COX regression analysis identified that ASA class III, severe pain, CRP≥5 mg/L and liver/peritoneal metastases were independent risk factors for prognosis of the patients. Conclusion: ASA class III, severe pain, high CRP level and liver/peritoneal metastases are indicators for a poor prognosis in advanced pancreatic cancer patients after palliative surgery.

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马湘,曲林林,张明进,胡骁,李坤.进展期胰腺癌患者姑息性旁路手术后的预后因素分析[J].中国普通外科杂志,2014,23(9):1195-1199.
DOI:10.7659/j. issn.1005-6947.2014.09.008

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  • 收稿日期:2014-05-12
  • 最后修改日期:2014-08-06
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  • 在线发布日期: 2014-09-15