根治性顺行性模块化胰脾切除术治疗胰体尾癌的初步经验(附52例报道)  

Preliminary experience of radical antegrade modular pancreatosplenectomy for pancreatic body and tail cancer: report of 52 cases

作　　者：秦双利 程坤[1] 韩玮[1] 陈启龙[1] 林海[1] 何铁英[1] 徐新建[1] QIN Shuangli;CHENG Kun;HAN Wei;CHEN Qilong;LIN Hai;HE Tieying;XU Xinjian(Department of Pancreatic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumchi 830054, P. R. Chin)

机构地区：[1]新疆医科大学第一附属医院胰腺外科,乌鲁木齐830054

出　　处：《中国普外基础与临床杂志》2018年第6期673-679,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：新疆维吾尔自治区卫生厅青年科技人才专项科研项目(项目编号:2014Y09)

摘　　要：目的总结根治性顺行性模块化胰脾切除手术(RAMPS)治疗胰体尾癌的单中心初步经验。方法回顾性分析2013年1月至2016年12月期间于新疆医科大学第一附属医院胰腺外科行RAMPS手术治疗的52例胰体尾癌患者的临床资料。结果 52例患者的手术均顺利完成,无住院期间或术后30 d内死亡病例。手术时间198~830 min、(463±137)min;术中出血量100~2 800 m L,中位数为400 m L,其中有19例(36.5%)术中输血。术后住院时间为7~58 d,中位时间为19.5 d。术后发生胰瘘18例,胃排空延迟5例,腹腔积液7例,胸腔积液3例,腹腔感染4例,腹腔出血2例。有2例患者接受再手术。术后51例患者获访,随访时间3~35个月,中位随访时间为18个月,所有患者的中位生存时间(MST)为16.2个月。随访期间21例复发转移,8例死亡。Cox比例风险回归模型结果表明,切缘[RR=3.65,95%CI为(0.06,5.11),P=0.026]和辅助治疗[RR=6.43,95%CI为(1.51,27.43),P=0.012]均与预后有关,切缘阴性和行辅助治疗患者的预后较好。结论 RAMPS治疗胰体尾癌安全可行,可能提高患者的R0切除率,联合辅助治疗有助于改善患者的预后。Objective To summarize the experience of single center for radical antegrade modular pancreatosplenectomy （RAMPS） in the treatment of pancreatic body and tail cancer. Methods The clinical data of 52 patients with pancreatic body and tail cancer who underwent RAMPS surgery in the First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2016 were retrospectively analyzed. Results All operations of the 52 patients were successfully completed, with no death during hospitalization and 30 days after surgery. The operative time was （463±137） min （198-830 min）, the median of intraoperative blood loss was 400 mL （100-2 800 mL）, of which 19 cases （36.5%） received intraoperative blood transfusion. The median of hospital stay was 19.5 days （7-58 days）. After operation, 18 patients suffered from pancreatic fistula, 5 patients suffered from delay gastric emptying, 7 patients suffered from peritoneal effusion, 3 patients suffered from pleural effusion, 4 patients suffered from abdominal infection, 2 patients suffered from abdominal bleeding. Reoperations were performed in 2 patients. There were 51 patients were followed up for 3-35 months （the median of 18 months） with the median survival time were 16.2 months. During the follow-up period, 21 patients suffered from recurrence or metastasis, of which 8 patients died. The results of Cox partial hazard model showed that, surgical margin ERR=3.65, 95% CI was （0.06, 5.11）, P=0.026] and adjuvant therapy [ RR=6.43, 95% CI was （1.51, 27.43）, P=0.012] were statistically related with prognosis, the prognosis of patients with negative surgical margin and underwent adjuvant therapy were better than those patients with positive surgical margin and didn＇t underwent adjuvant therapy. Conclusions RAMPS is safe and feasible in the treatment ofpancreatic body and tail cancer, and it may improve the RO resection rate. RAMPS combins with adjuvant therapy can contribute to better prognosis.

关 键 词：胰体尾癌 根治性顺行模块化胰脾切除术 预后 

分 类 号：R735.9[医药卫生—肿瘤]