门静脉/肠系膜上静脉和肠系膜上动脉手术切缘1mm内发现癌细胞对胰头癌预后的影响  

The impact of resection margin status within 1 mm clearance of portal and superior mesenteric vasculature on the prognosis of patients of pancreatic head adenocarcinoma undergoing pancreatoduodenectomy

作　　者：刘进衡 王妍亭 宋海宇 刘续宝[2] 柯能文[2] Liu Jinheng;Wang Yanting;Song Haiyu;Liu Xubao;Ke Nengwen(Department of Hepatobiliary-Pancreatic Surgery,Chengdu Second People's Hospital,Chengdu 610015,China;Department of Pancreatic Surgery,West China Hospital,Sichuan University,Chengdu 610041,China;West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]成都市第二人民医院肝胆胰外科,610015 [2]四川大学华西医院胰腺外科,成都610041 [3]四川大学华西公共卫生学院/华西第四医院,成都610041

出　　处：《中华普通外科杂志》2021年第7期489-493,共5页Chinese Journal of General Surgery

基　　金：四川省科技厅重点研发项目(2020YFS0262)。

摘　　要：目的分析胰腺的门静脉/肠系膜上静脉沟槽组织和毗邻肠系膜上动脉的钩突断端手术切缘1 mm内发现癌细胞对胰头癌患者行胰十二指肠切除术后预后的影响。方法回顾性分析113例行胰十二指肠切除术的胰头癌患者的临床资料、病理资料和随访资料。结果单因素分析显示手术切缘1 mm内发现癌细胞、术后是否进行辅助化疗、T分期、N分期、TNM分期、性别、肿瘤最大直径是影响患者生存预后的危险因素。多因素分析结果显示手术切缘1 mm内发现癌细胞、术后是否进行辅助化疗、性别是影响患者生存预后的独立危险因素。手术切缘1 mm内未发现癌细胞组(83例)中位生存时间为19.04个月,1、2、3年生存率分别为78%、50%、25%。手术切缘1 mm内发现癌细胞组(30例)中位生存时间为9.42个月,1、2、3年生存率分别为61%、20%、0。手术切缘1 mm内发现癌细胞组与手术切缘1 mm内未发现癌细胞组生存状况差异有统计学意义(P=0.018)。结论门静脉/肠系膜上静脉和肠系膜上动脉手术切缘1 mm内发现癌细胞是影响接受胰十二指肠切除术的胰头癌患者预后的独立危险因素。Objective To evaluate the impact of resection margin status within a cut-off 1 mm clearance of cancer on the groove of portal/superior mesenteric vein and/or the top end of the uncinate process bordering on the superior mesenteric artery in pancreatic head adenocarcinoma patients after pancreatoduodenectomy.Methods The clinical,pathological and followup data of 113 pancreatic head adenocarcinoma patients undergoing pancreatoduodenectomy with or without vascular graft replacement were retrospectively analyzed.Results Univariate analysis showed that resection margin 1mm clearance,postoperative adjuvant chemotherapy,T staging,N staging,TNM staging(AJCC),gender,and maximum tumor diameter were risk factors for survival.Multivariate analysis showed that surgical margin 1mm clearance,postoperative adjuvant chemotherapy,and gender were independent prognostic factors.In resection margin>1 mm group(83 cases),the mean survival time was 19.04 months,and the 1-year,2-year,and 3-year survival rates were 78%,50%,and 25%,respectively.In resection margin≤1 mm group(30 cases),the mean survival time was 9.42 months,and the 1-year,2-year and 3-year survival rates were 61%,20%and 0,respectively.There was statistical significance between the two groups in survival time(P=0.018).Conclusion Resection margins 1 mm clearance of cancer off portal vein/superior mesenteric vein and superior mesenteric artery is independent prognostic factors in pancreatic head adenocarcinoma patients undergoing pancreatoduodenectomy.

关 键 词：胰腺肿瘤 预后 门静脉 肠系膜上静脉 肠系膜上动脉 

分 类 号：R735.9[医药卫生—肿瘤]