胰腺体尾部癌外科治疗的几个焦点问题  

Several key issues in surgical treatment of distal pancreatic cancer

作　　者：王志东[1] 崔云甫[1] 

机构地区：[1]哈尔滨医科大学附属第二医院普通外科,黑龙江省哈尔滨市150086

出　　处：《世界华人消化杂志》2015年第16期2515-2522,共8页World Chinese Journal of Digestology

基　　金：黑龙江省科技计划基金资助项目;No.GC12C304-1~~

摘　　要：胰腺体尾部癌症状隐匿,恶性程度高,切除率低,预后差,整体治疗有待提高.外科手术是唯一可能治愈的手段,手术治疗为核心的多学科协作的个体化治疗策略应该成为标准模式."可能切除"患者先接受新辅助治疗,再判断是否手术有助于提高R0切除率,改善预后.根治性顺行胰腺体尾部癌整体切除术(radical antegrade modular pancreatosplenectomy,RAMPS)手术符合肿瘤切除原则,有望成为标准的根治手术方式.腹腔镜探查术能够发现肝转移和腹腔播散,避免不必要的开腹手术.腹腔镜下胰腺体尾部癌根治术与开腹手术相比有诸多优势,但仅限于肿瘤体积较小的早期患者,肿瘤学方面的远期效果仍需验证,建议有选择地开展.联合腹腔干切除的根治性远端胰腺癌切除术(radical distal or left pancreatectomy with resection of the celiac axis,DP-CAR)适合于肝总动脉或腹腔干受侵犯但仍有条件切除的患者,需谨慎开展.胰腺体尾部癌在早期诊断、分子水平个体化治疗方面需要突破,新辅助治疗和腹腔镜手术的开展需要进一步多中心联合前瞻实验研究提供循证证据支持.Distal pancreatic cancer is an aggressive malignancy with insidious and subtle presentation,low radical resection rate and poor prognosis.The effectiveness of treatments for this disease remains to be improved.Radical resection is the only curable treatment.Personalized therapeutic strategy with surgical resection as a core should be the standard mode for these patients,and a professional multidisciplinary team is indispensable.Patients with borderline resectable cancers may benefit from a neoadjuvant approach by initiating chemotherapy and/or chemoradiation prior to the resection.Radical antegrade modular pancreatosplenectomy（RAMPS） is designed to establish an operation with oncologic rationales and should be the standard radical resection mode for distal pancreatic cancer.The use of diagnostic laparoscopy can help find hepatic metastases and peritoneal dissemination to avoid an unnecessary open operation.Laparoscopic distal pancreatectomy has many advantages compared with open operation,but is only applicable to early-stage patients with small tumors.In addition,the long-term oncologic effects of this surgical procedure still need to be verified,and it should be carried out selectively.Radical distal（or left）pancreatectomy with resection of the celiac axis（DP-CAR） is proper for some patients with evidence of celiac arterial invasion and should be conducted meticulously.However,new breakthroughs in early diagnosis and genetically personalized therapy are urgently needed.We still need prospective,randomized studies in multicenter institutions to provide more evidence for the neoadjuvant approach and laparoscopic distal pancreatectomy.

关 键 词：胰腺体尾部癌 可能切除 腹腔镜手术 新辅助治疗 多学科协作 个体化治疗 根治性顺行胰腺体尾部癌整体切除术 联合腹腔干切除的根治性远端胰腺癌切除术 

分 类 号：R735.9[医药卫生—肿瘤]