海德堡三角清扫胰十二指肠切除术治疗胰头癌的临床疗效  

Clinical efficacy of pancreaticoduodenectomy with TRIANGLE operation in the treatment of pancreatic head cancer

作　　者：黄孝伦[1] 邹海波[1] 赖春友 姚豫桐[1] 向光明[1] 罗兰云[1] 骆乐[1] 王冠[1] 冯天航 谢坪[2] 曹磊[2] 李娟[3] Huang Xiaolun;Zou Haibo;Lai Chunyou;Yao Yutong;Xiang Guangming;Luo Lanyun;Luo Le;Wang Guan;Feng Tianhang;Xie Ping;Cao Lei;Li Juan(Department of Hepato-pancreato-biliary Surgery,Sichuan Provincial People′s Hospital,Affiliated Hospital of School of Medicine of University of Electronic Science and Technology of China,Chengdu 610008,China;Department of Intervention Center,Sichuan Provincial People′s Hospital,Affiliated Hospital of School of Medicine of University of Electronic Science and Technology of China,Chengdu 610008,China;Department of Pathology,Sichuan Provincial People′s Hospital,Affiliated Hospital of School of Medicine of University of Electronic Science and Technology of China,Chengdu 610008,China)

机构地区：[1]电子科技大学附属医院四川省人民医院肝胆胰外科,成都610008 [2]电子科技大学附属医院四川省人民医院介入中心,成都610008 [3]电子科技大学附属医院四川省人民医院病理科,成都610008

出　　处：《中华消化外科杂志》2022年第4期500-506,共7页Chinese Journal of Digestive Surgery

基　　金：国家重点基础研究发展计划(973计划)(2015CB964703);四川省科技厅重点转化项目(2017QN08);四川省科技厅项目(2018HH062);四川省科技厅重点项目(2018SZ110)。

摘　　要：目的:探讨海德堡三角清扫胰十二指肠切除术治疗胰头癌的临床疗效。方法:采用回顾性队列研究方法。收集2017年1月至2018年7月电子科技大学附属医院四川省人民医院收治的51例胰头癌患者的临床病理资料;男33例,女18例;中位年龄为56岁,年龄范围为42~74岁。51例患者中,24例行标准胰十二指肠切除术(清扫第12、13、17组淋巴结)联合介入动脉灌注化疗(TAI),设为标准组;27例行海德堡三角清扫胰十二指肠切除术(清扫第7、8、9、12、13、16、17组淋巴结)联合TAI,设为海德堡组。观察指标:(1)两组患者术中情况比较。(2)两组患者术后情况比较。(3)随访和生存情况。采用门诊和电话方式进行随访,术后每3个月随访1次,了解患者肿瘤复发转移及生存情况。随访时间截至2021年7月或患者死亡。正态分布的计量资料以x±s表示,组间比较采用t检验;偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示,组间比较采用χ^(2)检验或Fisher确切概率法。等级资料比较采用秩和检验。采用Kaplan-Meier法计算生存率和中位生存时间并绘制生存曲线,Log-Rank检验进行生存分析。结果:(1)两组患者术中情况比较。标准组患者手术时间、术中出血量、术中输血分别为(501±61)min、(563±278)mL、4例;海德堡组患者上述指标分别为(556±46)min、(489±234)mL、6例;两组患者手术时间比较,差异有统计学意义(t=3.62,P<0.05);两组患者术中出血量、术中输血比较,差异均无统计学意义(t=1.03,χ^(2)=0.25,P>0.05)。(2)两组患者术后情况比较。51例患者中,30例术后发生并发症(共50例次)。50例次总并发症中,Clavien-DindoⅠ级、Ⅱ级、Ⅲa级、Ⅲb级并发症分别为18、29、2、1例次。标准组患者术后发生并发症例数,胃排空障碍,胰瘘(无、A级、B级),胆瘘,出血,腹泻分别为15例,4例,13、7、4例,4例,2例,2例;海德堡组患者上述指标分别为15例,6例,1Objective:To investigate the clinical efficacy of pancreaticoduodenectomy with TRIANGLE operation in the treatment of pancreatic head cancer.Methods:The retrospective cohort study was conducted.The clinicopathological data of 51 patients with pancreatic head cancer who were admitted to the Sichuan Provincial People′s Hospital,Affiliated Hospital of School of Medicine of University of Electronic Science and Technology of China from January 2017 to July 2018 were collected.There were 33 males and 18 females,aged from 42 to 74 years,with a median age of 56 years.Of the 51 patients,24 cases undergoing standard pancreaticoduodenectomy,in which No.12,13 and 17 lymph nodes were dissected,combined with transcatheter arterial infusion chemo-therapy(TAI)were allocated into the standard group,and 27 cases undergoing pancreaticoduo-denectomy with TRIANGLE operation,in which No.7,8,9,12,13,16,17 lymph nodes were dissected,combined with TAI were allocated into the TRIANGLE group,respectively.Observation indicators:(1)intraoperative conditions of the two groups;(2)postoperative conditions of the two groups;(3)follow-up and survival.Follow-up was conducted using outpatient examination and telephone interview once three months to detect tumor recurrence and metastasis and survival of patients up to July 2021 or the death of patient.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were represented as M(range),and comparison between groups was analyzed using the chi-square test or the Fisher exact probability.Comparison of ordinal data was analyzed using the rank sum test.Kaplan‐Meier method was used to calculate the survival rate and median survival time and draw survival curve.Log‐Rank test was used for survival analysis.Results:(1)Comparison of intraoperative conditions between the two groups.The operation time,volume of intraoperative blood loss,cases with intraoperative blood transfusion were(501±6

关 键 词：胰腺肿瘤 海德堡三角 预后 并发症 淋巴结清扫 

分 类 号：R735.9[医药卫生—肿瘤]