扩大淋巴结清扫的胰十二指肠切除术治疗胰腺癌的临床意义  

The Clinical Significance of Extended Pancreaticoduodenectomy in the Treatment for Pancreatic Carcinoma

作　　者：弓毅[1] 许学军[1] 王槐志[1] 

机构地区：[1]第三军医大学西南医院全军肝胆外科研究所,重庆400038

出　　处：《肿瘤学杂志》2015年第10期816-818,共3页Journal of Chinese Oncology

摘　　要：[目的]探讨扩大淋巴结清扫的胰十二指肠切除术（PD）对于胰腺癌治疗的临床意义。[方法 ]回顾性分析195例行胰十二指肠切除术胰腺癌患者的临床及病理资料。根据手术方式不同将患者分为对照组：标准化淋巴结清扫的胰十二指肠切除术（110例）和实验组：扩大淋巴结清扫的胰十二指肠切除术（85例）。比较两组胰腺癌患者的手术情况、病理检查结果、术后并发症发生率、死亡率及术后生存时间等。[结果]实验组和对照组的平均手术时间分别为554min和443min,中位术中出血量分别为800ml和500ml,两组比较,差异均有统计学意义（P〈0.05）。实验组和对照组患者的死亡率分别为3.53%和3.64%,两组比较差异无统计学差异（χ2=0.483,P〉0.05）。实验组和对照组术后并发症发生率分别为27.1%和24.5%,两组比较差异无统计学意义（χ2=3.804,P〉0.05）。术后中位生存时间分别为18.6个月（95%CI：12.7～21.5）和16.9个月（95%CI：10.6～23.2）,两组比较差异无统计学意义（χ2=0.143,P〉0.05）。[结论 ]扩大淋巴结清扫的胰十二指肠切除术虽然增加了手术时间及出血量,但并不增加术后并发症的发生率和死亡率。虽然对患者预后影响差异无统计学意义,但扩大淋巴结清扫的PD术总体生存时间仍比标准淋巴结清扫PD术延长1.7个月。[ Purpose ] To investigate the clinical significance of extended pancreaticoduodenectomy in the treatment for pancreatic carcinoma. [Methods] The clinical and pathological data of 195 pancreatic cancer patients were analyzed retrospectively. According to the surgical procedures, patients were divided into two groups：control group（pancreaticoduodenectomy combined with rou- tine lymphadenectomy, 110 cases） and test group（pancreaticoduodenectomy combined with extended lymphadenectomy, 85 cases）. We performed a detailed statistical analysis of factors,including ope- rative factors,pathological type,postoperative complications,operative mortality and survival rate. [Results] The average operational duration of test group and control group were 554 min and 443 mirL The median intraoperative blood loss was 800ml and 500ml. There was statistically significant difference between the two groups（P〈0.05）. The mortality rate of test group and control group were 3.53% and 3.64%, respectively. The postoperative complication incidence was 27.1% and 24.5%. There was no statistically significance between the two values （P〉0.05）. The median overall sur- vival time for test group was 18.6 months,the 95% confidence interval was （12.7～21.5）,and con- trol group was 16.9 months with 95% confidence interval （10.6-23.2）. There was no statistically significance between the two values （χ2=0.143 ,P〉0.05）. [Conclusion] Compared with pancreati- coduodenectomy combined with routine lymphadenectomy,extended lymphadenectomy panereati- coduodenectomy increases operation time and the amount of blood loss without significantly in- creasing the mortality rate and the incidence of postoperative complications. There is no statisti- cally significance on the median survival time between the two groups. However,extended lym- phadenectomy pancreaticoduodenectomy can prolong patients＇ survival time for 1.7 months.

关 键 词：胰腺肿瘤 胰十二指肠切除术 扩大淋巴结清扫 

分 类 号：R735.9[医药卫生—肿瘤]