根治性切除胰头癌150例患者淋巴结转移的分布和特点  

Distribution of metastatic lymph nodes in 150 patients who underwent radical resection for pancreatic head cancer

作　　者：蒋永剑[1] 阎九亮[1] 金忱[1] 周仲文[2] 杨峰[1] 狄扬[1] 李骥[1] 姚洌[1] 郝思介[1] 唐峰[2] 傅德良[1] 

机构地区：[1]复旦大学附属华山医院胰腺外科、复旦大学胰腺病研究所,上海200040 [2]复旦大学附属华山医院病理科、复旦大学胰腺病研究所,上海200040

出　　处：《中华肝胆外科杂志》2012年第7期494-498,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：上海市科委“创新行动计划”（08411954300）;上海市领军人才计划（20LO）;上海市自然科学基金（11ZR1405500）

摘　　要：目的研究胰头癌淋巴转移的特点及其临床病理影响因素，为胰头癌手术合理的淋巴清扫提供理论依据。同时，验证手术显微镜法在胰头癌根治性切除标本中淋巴结检出的可靠性和有效性。方法根据日本胰腺学会制定的胰头癌淋巴结分组标准，对150例胰头癌根治性手术（胰十二指肠切除＋D2区域性淋巴结清扫）标本，应用已建立的手术显微镜法进行标本淋巴结检查，研究胰头癌转移淋巴结的分布、各组淋巴结转移发生频率和可能的影响因素；并将研究结果与2004年46例标本结果进行对比，进一步验证并分析手术显微镜法淋巴结转移检出的有效性。结果经病理证实，150例患者均为胰头导管腺癌，手术显微镜法每例找到淋巴结数平均为38．2枚，其中101例有淋巴结转移（淋巴结转移发生率为67．3％）。转移频率较高的淋巴结组有第13组（64．5％）、14组（51．7％）、17组（38．6％）、12组（25．8％）和16组（20．8％）。研究表明肿瘤大小、局部浸润、分化程度以及术前糖类抗原19—9和糖类抗原72—4水平与胰腺癌的淋巴结转移密切相关，而与患者性别、年龄和肿瘤部位没有明显的相关性。每例标本获取的平均淋巴结数、淋巴结转移发生率、各组淋巴结的转移频率与2004年的研究结果无明显差异，说明手术显微镜法是一稳定有效的胰腺癌淋巴结检出方法。结论可切除胰头癌患者存在较为广泛的淋巴结转移，应该进行根治性的淋巴清扫，以减少术后淋巴结转移的发生。手术显微镜法是一种稳定有效的胰腺癌淋巴结检出方法，有助于获取胰腺癌淋巴结转移研究所需的信息和准确的临床病理分期。Objective To study the characteristics and the impact of lymph node metastasis on radical resection for pancreatic head cancer to provide a theoretical basis for lymphadenectomy in radi- cal resection. To study the reliability of using a surgical microscope to detect lymph nodes in radically resected specimens of pancreatic head cancer. Methods Lymph nodes in the specimens after radical pancreaticoduodenectomy （pancreaticoduodenectomy Jr D2 regional lymphadenectomy） were identified using a surgical microscope and they were grouped using the JPS standard. The position and the fre- quency of the lymph nodes retrieved, and their association with other clinicopathologic factors were analysed. The results were compared with the data published in 2004 on 46 patients to evaluate the re- liability of using a surgical microscope. Results Lymph node metastasis was detected histopathologi- cally in 101 patients （67.3%）. The median number of lymph nodes retrieved in the specimens as de- tected using the surgical microscope was 38.2. The most commonly involved lymph node groups were No. 13 （64.5%）, No. 14 （51.7%）, No. 17 （38.6%）, No. 12 （25.8%）, No. 16 （20.8%）. Lymph node metastasis was significantly associated with tumour T stage, tumour invasion and differentiation,preoperative serum level of CA19-9 and CA72-4, but not with patient age, sex, or tumour location. There were no significant differences between the results and the data of the previous study in 2004. Conclusions Extended lymphadenectomy is necessary because extensive lymph node metastasis was common. Surgical microscopy is an effective and reliable method to detect lymph nodes in resected specimens of pancreatic head cancer for accurate pathologic staging.

关 键 词：胰腺肿瘤 胰十二指肠切除术 淋巴转移 显微外科手术 

分 类 号：R735.9[医药卫生—肿瘤]