扩大胰十二指肠切除与标准胰十二指肠切除治疗胰腺癌的临床研究  

Effect of extended pancreatoduodenectomy and standard pancreatoduodenectomy on perioperative indexes and postoperative complications in patients with pancreatic cancer

作　　者：黄长山[1] 余伟[1] 王谦[1] 丁月超[1] 马超[1] 黄涛[1] HUANG Chang-shan, YU Wei, WANG Qian, et al.(Hepatobiliary and pancreatic surgery, Henan Provincial Tumor Hospital,Zhenzhou 450003, Chin)

机构地区：[1]河南省肿瘤医院肝胆胰外科,郑州450003

出　　处：《肝胆外科杂志》2018年第1期35-38,共4页Journal of Hepatobiliary Surgery

摘　　要：目的对比分析扩大淋巴结清扫胰十二指肠切除手术(PD)与标准淋巴结清扫PD术治疗对胰腺癌患者围术期指标及术后并发症的影响。方法回顾性收集2011年3月~2014年3月我院收治的48例胰腺癌患者,根据治疗方式不同分为标准组(n=26)和扩大组(n=22),标准组行PD术联合常规淋巴结清扫,扩大组行PD术联合扩大淋巴结清扫。比较两组手术情况、术后恢复情况、术后并发症发生情况及术后疗效。结果扩大组较标准组手术时间明显延长(P<0.05),术中出血量及术中输血量明显增多(P<0.05)。扩大组与标准组在术后恢复流质饮食时间、引流管拔出时间、下床活动时间、术后住院时间及腹泻、吻合口瘘、腹腔出血、腹腔感染、胰漏、胆汁漏等并发症、总并发症发生率比较差异无统计学意义(P>0.05)。扩大组较标准组阳性淋巴结检出数明显增多(P<0.05);扩大组术后淋巴结转移、原位复发率均低于标准组,但差异无统计学意义(P>0.05)。随访显示,扩大组中位生存时间为14.5个月,标准组中位生存时间为13.7个月,组间比较差异无统计学意义(P>0.05)。结论对行PD术治疗的胰腺癌患者,予以扩大淋巴结清扫,虽延长了手术时间,增加术中出血量,但并不会明显增加术后并发症;虽可增加阳性淋巴结检出数目,但可能并不能延长患者生存时间。Objective To compare the effect of extended lymph node dissection pancreaticoduodenectomy （PD） and standard lymph node dissection PD on perioperative indicators and postoperative complications in patients with pancreatic cancer. Methods A total of 48 patients with pancreatic cancer who were admitted to the hospital from March 2011 to March 2014 were selected and divided into the standard group （n = 26） and the extended group （n = 22 ） according to different treatment methods. The standard group was treated with PD combined with conventional lymph node dissection, while the extended group was treated with PD combined with ex- tended lymph node dissection. The situation of operation, postoperative recovery, the incidence of postoperative complications and post- operative curative effect were compared between the two groups. Results The operation time of the expanded group was significantly longer than that of the standard group （ P 〈 0.05 ）, and the intraoperative blood loss and blood transfusion volume were significantly more than those of the standard group （ P 〈 0.05 ）. There was no significant difference between the two groups in the postoperative time of liquid diet recovery, time of drainage tube removal, ambulation time, postoperative hospitalization time or the incidence of complica- tions （ P 〉 0. 05 ）. The number of positive lymph nodes detected in the extended group was significantly larger than that in the standard group （P 〈 0. 05）. The rates of lymph node metastasis and in situ recurrence in the extended group after operation were lower than those in the standard group （ P 〉 0. 05 ）. Follow-up showed that the median survival time of the extended group and the standard group was 14.5 months and 13.7 months, respectively （ P 〉 0. 05 ）. Conclusion Although PD combined with extended lymph node dissec- tion prolongs the operation time and increases the blood loss, it will not significantly increase postoperative complications. It can increase the number of po

关 键 词：胰十二指肠切除术 扩大淋巴结清扫 标准淋巴结清扫 围术期指标 术后并发症 

分 类 号：R737[医药卫生—肿瘤]