腹腔镜胰十二指肠切除术在老年胰腺导管腺癌患者中的肿瘤学疗效研究  

Study on the oncological effect of laparoscopic pancreatoduodenectomy in elderly patients with pancreatic ductal adenocarcinoma

作　　者：梁贇 赵丽亭 姜翀弋 王巍 虞先濬 Liang Yun;Zhao Liting;Jiang Chongyi;Wang Wei;Yu Xianjun(Department of Pancreatic Surgery,Cancer Hospital Affiliated to Fudan University,Shanghai,200032,P.R.China;Department of Oncology,Shanghai Medical College of Fudan University,Shanghai,200032,P.R.China;Department of General Surgery,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China)

机构地区：[1]复旦大学附属肿瘤医院胰腺外科,上海200032 [2]复旦大学上海医学院肿瘤学系,上海200032 [3]复旦大学附属华东医院普外科,上海200040

出　　处：《老年医学与保健》2021年第1期68-72,共5页Geriatrics & Health Care

基　　金：上海市卫生健康委员会科研基金(20194Y0195)。

摘　　要：目的研究腹腔镜胰十二指肠切除术在老年胰腺导管腺癌患者中的肿瘤学疗效。方法回顾性分析自2015年1月-2017年12月在复旦大学附属华东医院普外科完成胰十二指肠切除术治疗的胰腺导管腺癌、年龄≥60岁患者的临床资料。根据其手术方式分为腹腔镜(LPD)组与开放(OPD)组,并对2组的手术及肿瘤学资料进行比较。结果共入组46例患者,其中LPD组19例,DPD组27例。LPD组的中位术中出血量少于OPD组(300 mL vs 500 mL),差异有统计学意义。2组的淋巴结清扫个数,R0切除率,AJCC分期差异无统计学意义。63.2%的LPD组患者和59.3%的OPD组患者接受了术后辅助化疗,其中LPD组术后中位开始化疗时间为42 d,OPD组为41 d。中位随访时间为18个月,随访期间,73.7%的LPD组患者和77.8%的OPD组患者出现复发。LPD组的中位生存时间为19个月,而OPD组为14.7个月,Log-Rank P=0.29,差异无统计学意义。结论在老年胰腺导管腺癌患者,腹腔镜胰十二指肠切除术的肿瘤学疗效与开放手术相当。但与开放手术相比,腹腔镜手术术中出血少,因此,对于老年胰腺导管腺癌患者需行胰十二指肠切除术,可以考虑选择腹腔镜手术。Objective To evaluate the oncological effect of laparoscopic pancreatoduodenectomy(LPD)in elderly patients with pancreatic ductal adenocarcinoma(PD AC).Methods The clinical data of patients with PD AC aged over 60 years who underwent pancreatoduodenectomy in Department of General Surgery,Huadong Hospital Affiliated to Fudan University from January 2015 to December 2017 were retrospectively analyzed.They were divided into LPD group and open pancreaticoduodenectomy(OPD)group according to the operation methods,and the operation and oncology data of the two groups were compared.Results A total of 46 patients were enrolled,including 19 ones in the LPD group and 27 ones in the OPD group.The median intraoperative blood loss in the LPD group was less than that in the OPD group(300 mL vs 500 mL),and the difference was statistically significant.There was no significant difference in the number of lymph node dissection,R0 resection rate and AJCC stage between the two groups.63.2%of patients in LPD group and 59.3%of ones in OPD group received postoperative adjuvant chemotherapy.The median time to start chemotherapy was 42 days in LPD group and 41 days in OPD group.The median follow-up time was 18 months.During the follow-up period,73.7%of patients in the LPD group and 77.8%of patients in the OPD group had recurrence.The median survival time of the LPD group was 19 months,while that of the OPD group was 14.7 months,the difference was not statistically significant(Log-Rank P=0.29).Conclusion In elderly patients with PD AC,the oncological effect of LPD is similar to that of OPD.However,compared with OPD,LPD has less intraoperative blood loss.Therefore,for elderly patients with PD AC who need pancreatoduodenectomy,LPD can be considered.

关 键 词：老年 胰腺导管腺癌 胰十二指肠切除术 腹腔镜 

分 类 号：R735.9[医药卫生—肿瘤]