规范化区域淋巴结清扫在胰头癌胰十二指肠切除术中的临床意义  

The clinical significance of standardized regional lymph node dissection in pancreatic head cancer pancreatoduodenectomy

作　　者：李更天 胡智明[2] 赵大建[2] 邵钦树[2] 邹寿椿[2] 张成武[2] 

机构地区：[1]浙江省东阳市中医院外科,浙江金华322100 [2]浙江省人民医院肝胆外科,浙江杭州310014

出　　处：《肝胆胰外科杂志》2011年第5期369-372,共4页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨规范化区域淋巴结清扫在胰头癌胰十二指肠切除术(PD)中的临床意义。方法对2008年1月至2010年10月收治的48例胰头癌患者施行在常规whipple基础上进行规范化区域淋巴结清扫。采用JPS的淋巴结分组标准,规范化区域淋巴结清扫的重点清扫肝总、肝固有动脉周围所有淋巴结(8a,8p)、腹腔干周围淋巴结(9)、肝十二指肠韧带区所有淋巴结(12abp)、胰十二指肠后的淋巴结(13a、13b)、从SMA开口至胰十二指肠下动脉(IPDA)间的SMA右侧的淋巴结(14abcd)及胰十二指肠前的淋巴结(17a、17b)、腹腔干至肠系膜下动脉(IMA)间的腹主动脉与下腔静脉前面的淋巴结(16a2、16b1)并包含Gerota筋膜。结果 48例胰腺癌患者施行规范化区域淋巴结清扫,术中常规行胰腺、胆管断面检查,证实无癌残留。2例患者肠系膜上静脉部分切除并血管重建,术后多脏器功能衰竭死亡1例。并发少量胰瘘2例,发生胃瘫1例,切口感染3例,急性左心衰1例,均治愈。48例患者累计清扫淋巴结716个,平均每例14.9个。其中有20例(41.6%)发生淋巴结转移,其中以胰十二指肠后(13a、13b)(14/48)29.1%、肠系膜上动脉周围淋巴结缔组织(14abcd)(8/48)16.7%发生率最高;N1阳性(8/20,40.0%),N2阳性(6/20,30.0%),N3阳性(6/20,30.0%)。结论规范化区域淋巴结清扫可以有效清扫区域内更多淋巴结和后腹膜组织,同时没有增加其手术的死亡率和并发症。Objective To explore and discuss the clinical significance of standardized regional lymph node dissection in pancreatic head cancer pancreatoduodenectomy.Methods Forty-eight cases of pancreatic head cancer with standardized regional lymph node dissection based on the conventional whipple from January 2008 to October 2010 in our department were retrospectively analyzed.The standardized regional lymph node dissection was performed using the JPS lymph node group standard（5th edition,2002）,which includes all lymph nodes around the hepatic artery（8a,8p）,the celiac trunk（9） and the hepatoduodenal ligament（12habpc）,all lymph nodes behind pancreas and duodenum（13a,13b）,lymph nodes near the right side of SMA from the start part of SMA to inferior pancreaticoduodenal artery（IPDA）（14abcd）,lymph nodes in front of pancreas（17a,17b）,lymph nodes in front of the abdominal aorta and inferior vena cava from celiac artery to superior mesenteric artery（IMA） as well as the Gerota fascia.Results The entire 48 patients received whipple D2 radical surgery included standardized regional lymph node dissection,and all of the cases were performed the pancreatic and biliary-section examination that confirmed no positive during the surgery.One of the patients received the partial resection and reconstruction of the superior mesenteric vein because of the tumor invading.After the surgery,2 cases complicated with a small amount of pancreatic fistula,2 cases of gastric paralysis,3 cases of wound infection,1 case of acute left ventricular failure,and 1 died from multiple organ failure.The pathological report showed there were lymph node metastasis in 20 cases（41.6%） among 48 patients,in which,back of pancreas and duodenum（13a,13b）,lymph nodes around the start part of SMA（14abcd） were the highest incidence places（8/48,16.7%）.Of all the cases,N1 lymph nodes metastasis were found in 4 people（8/20,40.0%）,N2 lymph nodes metastasis in 3 people（6/20,30.0%）,N3 lymph nodes metastasis in 3 people�

关 键 词：胰腺肿瘤 胰头十二指肠切除术 淋巴结切除术 

分 类 号：R735.9[医药卫生—肿瘤]