门静脉/肠系膜上静脉病理学肿瘤侵犯在胰十二指肠切除术中的临床意义  

Clinical significance of portal or superior mesenteric vein invasion during pancreaticoduodenectomy for pancreatic adenocarcinoma

作　　者：任浩源[1] 麦刚[1] 柯能文[2] 刘续宝[2] REN Haoyuan;MAI Gang;KE Nengwen;LIU Xubao(Department of Gastrointestinal Surgery,People’s Hospital of Deyang,Deyang,Sichuan 618000,P.R.China;Department of Pancreatic Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]德阳市人民医院胃肠外科,四川德阳618000 [2]四川大学华西医院胰腺外科,成都610041

出　　处：《中国普外基础与临床杂志》2021年第10期1301-1307,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省卫生健康委员会科研课题普及应用项目(项目编号:20PJ251);四川大学华西医院“135”工程特色专病/专项技术项目(项目编号:ZY20173021-3-5)。

摘　　要：目的评估门静脉(portal vein,PV)/肠系膜上静脉(superior mesenteric vein,SMV)病理学受侵在胰腺癌行胰十二指肠切除术(pancreaticoduodenectomy,PD)中的意义以及在无PV/SMV病理学侵犯的胰腺癌患者常规行PD联合PV/SMV切除的临床价值。方法选取2013年1月1日至2017年12月31日期间在笔者所在的两家医院收治的183例行PD的胰腺癌患者,81例为PD联合PV/SMV切除,其中42例(51.9%)PV/SMV有病理学侵犯(PD+P/S+组),39例(48.1%)无病理学侵犯(PD+P/S–组);102例为未行PV/SMV切除的标准PD(PD组)。应用多因素分析来确定影响生存的预后因素,Kaplan-Meier方法估算患者的生存期。结果PD+P/S+组、PD+P/S-组和PD组患者的年龄、性别、术前血清CA19-9水平、失血量、肿瘤大小、肿瘤分期、阳性淋巴结、阳性淋巴结比率、肿瘤分化程度、神经侵犯、术后辅助化疗、手术方式及切缘状态比较差异均无统计学意义(P>0.05),PD联合PV/SMV切除组与PD组之间的并发症发生率、病死率差异均无统计学意义(P>0.05),均无再手术发生;单因素分析显示,PD+P/S+组、PD+P/S–组和PD组之间的总生存期(overall survival,OS)差异有统计学意义(P<0.001),中位生存期分别为10个月、19个月和20个月。多因素生存分析结果显示,PV/SMV肿瘤浸润深度、术后辅助化疗和肿瘤分化程度是影响患者OS的独立预后因素。结论无论是否切除PV/SMV,有PV/SMV病理学侵犯患者的OS明显较无PV/SMV侵犯者差,血管内膜受肿瘤侵犯可能是真正影响胰腺癌患者OS的原因。PV/SMV无病理学侵犯行PD联合PV/SMV切除者与仅行PD者的OS无差异,患者是否可以从常规PV/SMV切除中受益还存在争议。Objective To evaluate the effect of pathological portal vein(PV)/superior mesenteric vein(SMV invasion during pancreaticoduodenectomy(PD)for pancreatic adenocarcinoma and the clinical significance of PD with PV/SMV resection in patients without pathological evidence of venous invasion.Methods From January 1,2013 to December 31,2017,data of 183 patients who had PD for pancreatic adenocarcinoma were collected.Eighty-one patients had PD with PV/SMV resection for pancreatic adenocarcinoma,among them,42 cases(51.9%)had pathological PV/SMV invasion(PD+P/S+group)and 39 patients(48.1%)didn’t have pathological PV/SMV invasion(PD+P/S-group).One hundred and two patients had a standard PD without PV/SMV resection(control group).Multivariate analysis was used to identify predictive variables which influencing survival and the Kaplan-Meier method to estimate patients’survival.Results There were no differences in gender,age,preoperative serum CA19-9 level,blood loss,tumor size,tumor TNM stage,positive lymph nodes,ratio of positive lymph nodes,degree of tumor differentiation,perineural invasion,postoperative adjuvant chemotherapy,type of operation,and margin status among 3 groups(P>0.05).And moreover,no significant differences were found between the PD combined PV/SMV resection group and the control group in the incidence of complications and mortality(P>0.05)and all no reoperation happened.Univariate analysis revealed a significant difference in overall survival(OS)among the PD+P/S+group,PD+P/S–group and control group(P<0.001),median survival time were 10,19 and 20 months,respectivly.Moreover,depth of PV/SMV invasion,use of postoperative adjuvant chemotherapy and tumor differentiation were independent prognostic factors by multivariate survival analysis.Conclusions OS of patients with PV/SMV invasion is significantly worse than that of patients without PV/SMV invasion,no matter underwent PV/SMV resection or not.The cause of that maybe invade to the tunica intima by tumor limits OS of patients with pancreatic adenocarcinom

关 键 词：胰腺癌 胰十二指肠切除术 门静脉 肠系膜上静脉 术后辅助化疗 

分 类 号：R735.9[医药卫生—肿瘤]