标准化和非标准化处理胰头癌切除标本的临床研究  

Clinical study on standardized and nonstandardized protocol for the pathological examination of pancreatic head cancer specimen

作　　者：彭颖[1] 修典荣[1] 石雪迎[2] 苏静[1] 马朝来[1] 蒋斌[1] 原春辉[1] 李磊[1] 陶明[1] 贾易木[1] 

机构地区：[1]北京大学第三医院普通外科,100191 [2]北京大学第三医院病理科,100191

出　　处：《中华普通外科杂志》2014年第5期329-333,共5页Chinese Journal of General Surgery

摘　　要：目的探讨一种标准化处理胰头癌切除标本的方法对肉眼判断边缘阴性而病理报告阳性（R1）切缘发生率的影响。方法2010年11月—2013年6月，前瞻性收集北京大学第三医院普外科同一手术组对胰头肿瘤行胰头十二指肠切除术的临床和病理资料，获得由病理证实为胰腺导管腺癌的患者60例（标准化组，n=60），除取胰颈断端、胆总管断端、胃体空肠断端外，还用缝线或不同颜色标记胰头前表面、肠系膜上静脉（SMV）沟切缘、肠系膜上动脉（SMA）切缘与胰头后表面，采用规范的方法对标本进行取材。以切缘检出肿瘤细胞为R1。回顾分析我科同一手术组2006年1月--2010年11月68例胰腺导管腺癌行根治性胰十二指肠切除的资料（非标准化组，n=68），对两组资料进行比较。结果标准化组和非标准化组在年龄、性别、肿瘤分级、肿瘤大小、T分期、手术方式及淋巴结转移等方面均无明显差异。标准化组R1切缘发生率（24／60，40．0％）高于非标准化组（11／68，16．2％，χ2=9．106。P=0．003）。SMV沟切缘（12／31，38．7％）和SMA切缘（13／31，41．9％）是最常受累及的切缘。29．2％（7／24）的患者同时累及两个切缘。结论对胰头癌切除标本进行标准化处理能够显著提高R1切缘的发生率，其中SMV沟切缘和SMA切缘是R1发生率最高的部位。Objective Toexplore a standard technique for the processing and reporting the R1 rate of the pancreatic head cancer. Methods We present a single team experience with 60 consecutive macroscopic complete pancreatic head resections for pancreatic ductal adenocarcinoma （PDAC） carried out between Nov 2011 and Jun 2013 by using standardized pathological protocol （SP, n = 60）. The pancreatic transection margin, as well as the bile duct and stomach/jejunum margins and the circumferential soft margins （SMV groove margin, SMA margin and posterior surface） , were sampled and analyzed. R1 was defined as tumor cells are present at the surface of the margins. Sixty-eight consecutive macroscopic complete pancreatic head resections carried out for PDAC without a standardized potocol between Jan 2006 and Nov 2010 were used as a control group（NSP, n =68）. Results There was no difference between SP group and NSP group in tumor T stage, lymph node metastasis and operation type. However, there was a statistically significant difference in the R1 rate between the groups, with 16. 2% （11/68） in NSP group and 40. 0% （24/60） in SP group （X2 = 9. 106, P = 0. 003）. SMV groove margin （ 12/31,38.7% ） and SMA margin （13/31,41.9%） were the two most often involved margins. Both margins were involved in 7 cases （7/24, 29.2% ）. Conclusions The standardized technique significantly detected higher R1 rate of the resection margin for the pancreatoduodenectomy specimen. SMV groove margin and SMA margin were the two most frequently involved margins.

关 键 词：胰腺肿瘤 胰十二指肠切除术 病理学 临床 切缘 

分 类 号：R735.9[医药卫生—肿瘤]