胰十二指肠切除术中扩大淋巴结清扫与标准淋巴结清扫治疗胰头癌的临床研究  

Efficacies of Extended Versus Standard Lymphadenectomy in Pancreatoduodenectomy for Pancreatic Head Adenocarcinoma

作　　者：王伟[1] 陶京 汤志刚[1] 武伦 叶林 姚黎超 WANG Wei;TAO Jing;TANG Zhigang;WU Lun;YE Lin;YAO Lichao(Department of Pancreatic Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院胰腺外科

出　　处：《中国肿瘤外科杂志》2019年第6期429-432,共4页Chinese Journal of Surgical Oncology

摘　　要：目的比较胰十二指肠切除术(PD)中标准淋巴结清扫(SPD)与扩大淋巴结清扫(EPD)治疗胰头癌的临床疗效。方法回顾性分析2010年1月至2014年1月在武汉大学人民医院普外科接受PD的79例胰腺癌患者临床资料,根据PD中淋巴结清扫范围分为标准淋巴结清扫组(SPD组,40例)和扩大淋巴结清扫组(EPD组,39例)。比较两组患者的围手术期资料及术后疗效;并对患者进行随访,统计患者的生存情况。结果与SPD组比较,EPD组手术时间明显延长[(512±68)min vs.(398±52)min,P<0.05],术中出血量明显增多[(732±72)ml vs.(482±34)ml,P<0.05]。两组术后总并发症发生率差异无统计学意义(43.6%vs.32.5%,P>0.05),而EPD组术后腹泻、胃排空障碍发生率高于SPD组(P<0.05);两组术后住院时间差异无统计学意义(P>0.05),但EPD组住院费用高于SPD组(P<0.05)。EPD组淋巴结获得数多于SPD组(19.4±11.7 vs.13.6±5.2,P<0.05),而阳性淋巴结数目差异无统计学意义(5.6±2.3 vs.4.3±2.1,P>0.05);SPD组与EPD组1、3、5年生存率和中位生存期差异均无统计学意义(65.0%vs.53.8%;22.5%vs.15.4%;12.5%vs.7.7%;16.5个月vs.14.0个月,P>0.05)。结论PD中行扩大淋巴结清扫治疗胰腺导管腺癌不能提高患者生存率,但会延长手术时间,增加术中出血量,甚至可能导致术后并发症的增加。Objective The aim of this study was to compare the efficacies of the extend lymphadenectomy in pancreatoduodenectomy(EPD)with standard lymphadenectomy(SPD)for pancreatic head adenocarcinoma.Methods The clinical outcomes of 79 cases of pancreatic cancer patients who underwent pancreaticoduodenectomy in general surgery department of Renmin Hospital of Wuhan University from January 2010 to January 2014 were retrospectively analyzed,and were divided into the standard group(n=40)and the expanded group(n=39)according to the lymph node dissection scope,standard group received PD combined with conventional lymph node dissection,and expanded group received PD combined with expanded lymph node dissection,and the perioperative outcomes and postoperative survival rates of the two groups were compared.Results The operation time of expanded group was obviously longer than standard group(512±68 min vs.398±52 min,P<0.05),the volume of intraoperative blood loss was lager(732±72 ml vs.482±34 ml,P<0.05).The postoperative complications of extended group was slightly higher than standard group,but there was no statistically significant difference(43.6%vs.32.5%,P>0.05),while postoperative diarrhea and gastric emptying delay were significantly higher(30.8%vs.10.0%;23.1%vs.5.0%;P<0.05).There was no statistically significant difference of postoperative hospital stay between the two group(P>0.05),but the hospitalization cost of expanded group is higher than the standard(P<0.05).The number of lymph nodes harvested significantly more when extended group compared with standard group(19.4±11.7 vs.13.6±5.2,P<0.05),while the number of positive lymph nodes was comparable(5.6±2.3 vs.4.3±2.1,P>0.05);Although the 1-year,3-year and 5-year survival rates and median survival period in the standard group were higher than those in the extended group,respectively,the difference between the two groups was not statistically significant(65.0%vs.53.8%;22.5%vs.15.4%;12.5%vs.7.7%;16.5 mon vs 14.0 mon,P>0.05).Conclusions EPD for pancreatic ductal adenoc

关 键 词：胰腺肿瘤 胰十二指肠切除术 淋巴结切除术 胰腺导管腺癌 扩大淋巴结清扫 标准淋巴结清扫 

分 类 号：R73[医药卫生—肿瘤]