扩大淋巴结清扫范围的胰十二指肠切除术治疗胰头癌的临床效果分析  

Clinical effect of pancreatoduodenectomy with enlarged lymph node dissection in the treatment of pancreatic head cancer

作　　者：薛佳豪 吴阳[1] XUE Jiahao;WU Yang(Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院肝胆胰外科,河南郑州450052

出　　处：《肿瘤基础与临床》2022年第2期123-126,共4页journal of basic and clinical oncology

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190137)。

摘　　要：目的探讨扩大淋巴结清扫范围的胰十二指肠切除手术(PD)治疗胰头癌(PHC)的临床效果。方法回顾性分析2016年8月至2021年6月在郑州大学第一附属医院行PD且术后病理学检查结果证实为PHC的64例患者的临床病理学资料。依据手术治疗方案的不同将患者分为标准的PD组(标准组)32例和扩大淋巴结清扫范围的PD组(扩大组)32例,对比2组患者手术时间、术中出血量、阳性淋巴结清扫数量、术后并发症的发生率、术后1 a生存率、术后3 a生存率、淋巴结转移率及原位复发率。结果扩大组的手术时间(254.34±36.39)min,较标准组的(214.31±19.14)min长,差异有统计学意义(t=5.509,P<0.001);扩大组术中出血量(270.59±55.45)mL,较标准组的(253.31±47.97)mL多,但差异无统计学意义(t=1.333,P=0.187);扩大组术中的阳性淋巴结清扫个数14.37±2.30,较标准组的11.95±2.18多,差异有统计学意义(t=4.320,P<0.001);扩大组术后并发症总发生率为21.88%(7/32),标准组为15.63%(5/32),差异无统计学意义(χ^(2)=0.410,P=0.522);扩大组术后1、3 a生存率及原位复发率分别为65.63%(21/32)、37.50%(12/32)、3.13%(1/32),标准组分别为68.75%(22/32)、34.37%(11/32)、9.38%(3/32),比较差异均无统计学意义(χ^(2)=0.071,P=0.790;χ^(2)=0.068,P=0.794;χ^(2)=1.067,P=0.302);扩大组患者术后淋巴结转移率为3.13%(1/32),低于标准组的18.75%(6/32),差异有统计学意义(χ^(2)=4.010,P=0.045)。结论扩大淋巴结清扫范围的PD能够降低PHC患者术后淋巴结转移风险,但无法延长患者术后的生存期,也不会增加术后并发症的发生率。Objective To explore the effect of pancreatoduodenectomy(PD)with enlarged lymph node dissection on pancreatic head cancer(PHC),and to analyze its clinical value.Methods The clinical and pathological data of 64 patients who underwent PD in the First Affiliated Hospital of Zhengzhou University from August 2016 to June 2021 and were confirmed to be PHC by postoperative pathological examination were retrospectively analyzed.According to different surgical treatment schemes,the patients were divided into the standard PD group(the standard group)with 32 cases and enlarged lymph node dissection in the PD group(enlarged group)with 32 cases.The operation time,intraoperative blood loss,number of positive lymph node dissection,incidence of postoperative complications,1-year survival rate,3-year survival rate,lymph node metastasis rate and in situ recurrence rate were compared between the two groups.Results The average operation time of the enlarged group[(254.34±36.39)min]was longer than that of the standard group[(214.31±19.14)min],and the difference was statistically significant(t=5.509,P<0.001).The average intraoperative blood loss in the enlarged group[(270.59±55.45)mL]was more than that in the standard group[(253.31±47.97)mL],but the difference was not statistically significant(t=1.333,P=0.187).The number of positive lymph nodes dissected in the enlarged group(14.37±2.30)was significantly more than that in the standard group(11.95±2.18),and the difference was statistically significant(t=4.320,P<0.001).The postoperative complication rate was 21.88%(7/32)in the enlarged group and 15.63%(5/32)in the standard group,and the difference was not statistically significant(χ^(2)=0.410,P=0.522).The 1-year,3-year survival rates and in situ recurrence rates in the enlarged group were 65.63%(21/32),37.50%(12/32),3.13%(1/32),the standard group was 68.75%(22/32),34.37%(11/32),9.38%(3/32)respectively,there was no statistically significant difference(χ^(2)=0.071,P=0.790;χ^(2)=0.068,P=0.794;χ^(2)=1.067,P=0.302)between the two g

关 键 词：扩大淋巴结清扫 胰十二指肠切除手术 胰头癌 临床疗效 预后 

分 类 号：R735.9[医药卫生—肿瘤]