腹腔镜下动脉优先入路次全远端胰腺切除术治疗新辅助化疗后胰颈体癌  

Laparoscopic subtotal distal pancreatectomy using the arterial first approach in patients who underwent post-neoadjuvant chemotherapy for pancreatic neck-body cancer

作　　者：李佳[1] 李国光[1] 胡脉涛 陈少丰 谢阳云[1] 彭创[1] 成伟[1] Li Jia;Li Guoguang;Hu Maitao;Chen Shaofeng;Xie Yangyun;Peng Chuang;Cheng Wei(Department of Pancreatic and Splenic Surgery,Hunan Provincial People's Hospital(the First Affiliated Hospital of Hunan Normal University),Changsha 410005,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)胰脾外科,长沙410005

出　　处：《中华肝胆外科杂志》2022年第10期755-760,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：湖南省临床医疗技术创新引导项目(2020SK50912);湖南省卫生健康委年度科研计划项目(C2019057)。

摘　　要：目的:探讨腹腔镜下动脉优先入路次全远端胰腺切除术治疗新辅助化疗后胰颈体癌的安全性及疗效。方法:回顾性分析2019年1月至2021年6月湖南省人民医院胰脾外科胰颈体癌新辅助化疗后行腹腔镜下次全远端胰腺切除术患者的临床资料。7例胰颈体癌患者纳入研究,其中男性3例,女性4例,年龄55(46,67)岁。总结分析患者化疗、术前、术中、术后指标以及随访结果。采用门诊、微信或电话方式随访。结果:7例患者中5例交界可切除患者采用AG方案(吉西他滨+白蛋白结合型紫杉醇)化疗,2例局部进展期患者采用mFOLFIRINOX方案(奥沙利铂+伊立替康+亚叶酸钙+氟尿嘧啶)化疗。7例患者均采用肠系膜上动脉优先入路并行门静脉/肠系膜上静脉切除重建。手术时间400(350,440)min,术中出血量300(150,400)ml。2例患者出现术后并发症,B级胰瘘和顽固性腹水各1例。术后住院时间11(10,14)d。7例患者均为R_(0)切除。随访时间9~33个月,5例患者无瘤生存,1例带瘤生存,1例复发死亡。结论:在严格把握适应证的前提下,腹腔镜下次全远端胰腺切除术治疗新辅助化疗后的胰颈体癌安全可行,患者可生存获益。Objective To study the safety and efficacy of laparoscopic subtotal distal pancreatectomy using the arterial first approach in treatment of patients with pancreatic neck-body cancer after neoadjuvant chemotherapy.Methods The clinical data of patients who underwent laparoscopic subtotal distal pancreatectomy after neoadjuvant chemotherapy at the Department of Pancreatic Surgery,Hunan Provincial People's Hospital from January 2019 to June 2021 were analyzed retrospectively.Seven patients were included in this study.There were 3 males and 4 females,aged 55(46,67)years old.The clinical data analysed included chemotherapy,preoperative,intraoperative,postoperative and follow-up data.Follow up was done by outpatient visits,or contact using wechat or telephone.Results Five borderline staged patients were treated with the AG chemotherapy regimen(gemcitabine+albumin-bound paclitaxel),and two patients with locally advanced stage were treated with the mFOLFIRINOX chemotherapy regimen(oxaliplatin+irinotecan+calcium folate+fluorouracil).All the 7 patients underwent portal vein/superior mesenteric vein resection and reconstruction using the superior mesenteric artery priority approach.The operation time was 400(350,440)min,and the intraoperative blood loss was 300(150,400)ml.Postoperative complications occurred in 2 patients with grade B pancreatic fistula and refractory ascites in 1 patient each.The postoperative hospital stay was 11(10,14)days.All 7 patients underwent R_(0) resection.During a follow-up period of 9 to 33 months,5 patients were still alive without tumor,1 patient survived with tumor,and 1 patient had died of recurrence.Conclusion In selected cases,laparoscopic subtotal distal pancreatectomy for pancreatic neck-body cancer after neoadjuvant chemotherapy was safe and feasible.

关 键 词：腹腔镜检查 胰腺颈体部癌 新辅助化疗 动脉优先 次全远端胰腺切除术 

分 类 号：R735.9[医药卫生—肿瘤]