肝胰病灶同步手术切除治疗胰腺癌合并肝寡转移  

Synchronous resection of hepatopancreatic lesions in treatment of hepatic oligometastatic pancreatic cancer

作　　者：钟明 万文武 蒋鸥[3] 姚辉华[4] 丁兵[1] ZHONG Ming;WAN Wenwu;JIANG Ou;YAO Huihua;DING Bing(Department of Hepatobiliary Surgery,Neijiang Second People’s Hospital,Neijiang,Sichuan 641000,P.R.China;Neijiang Health Vocational College,Neijiang,Sichuan 641000,P.R.China;Tumor Center,Neijiang Second People’s Hospital,Neijiang,Sichuan 641000,P.R.China;Department of Hepatobiliary Surgery,Chengdu First People’s Hospital,Chengdu 610095,P.R.China)

机构地区：[1]内江市第二人民医院肝胆外科,四川内江641000 [2]内江卫生与健康职业学院,四川内江641000 [3]内江市第二人民医院肿瘤中心,四川内江641000 [4]成都市第一人民医院肝胆外科,成都610095

出　　处：《中国普外基础与临床杂志》2022年第11期1452-1457,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：国家科技重大专项(民口)课题(项目编号:2018ZX09303-014);四川省医学会科研课题计划项目(项目编号:S20062)。

摘　　要：目的 探讨肝胰病灶同步手术切除治疗胰腺癌合并肝寡转移的疗效。方法 回顾性收集内江市第二人民医院2016年1月至2020年12月期间收治的54例胰腺癌合并肝寡转移患者的临床病理资料,收集的患者按治疗方式分为行肝胰病灶同步手术切除组(切除组)和行包括姑息性旁路手术、经皮经肝穿刺胆道引流或内镜支架置入以及全身系统化学药物治疗在内的保守治疗组(未切除组)。随访至2021年12月,比较2组患者的总生存时间并分析其影响因素。结果 本研究共收集到符合纳入和排除标准的患者54例,其中切除组31例、未切除组23例,2组患者的基线资料如年龄、性别、术前肝功能指标等比较差异均无统计学意义(P>0.05)。切除组有7例(22.6%)发生胰肠吻合口漏,2组在其他并发症方面比较差异均无统计学意义(P>0.05)。切除组和未切除组术后中位随访时间分别为14和11个月,2组患者的中位总生存时间分别为18.0个月[95%CI(13.8,22.1)]和12.0个月[95%CI(8.2,15.8)], log-rank检验结果显示,切除组的生存情况优于未切除组(χ~2=4.074,P=0.045)。Cox比例风险回归分析结果显示,白蛋白水平低(≤35.0 g/L)、未行围术期化学药物治疗及未行同步手术切除病灶缩短胰腺癌合并肝寡转移患者的总生存时间(P<0.05),对于其中行肝胰病灶同步手术切除者,达到R0切除和行围术期化学药物治疗能延长其术后总生存时间(P<0.05)。结论 从本研究结果看,肝胰病灶同步手术切除能使胰腺癌合并肝寡转移患者生存获益,未行R0切除及未联合围术期化学药物治疗患者预后较差。Objective To explore the curative effect of synchronous resection of hepatopancreas lesions in the treatment of hepatic oligometastatic pancreatic cancer. Methods The patients with hepatic oligometastatic pancreatic cancer who met the inclusion and exclusion criteria in the Neijiang Second People’s Hospital from January 2016 to December 2020 were retrospectively collected. The enrolled patients were divided into resection group and nonresection group according to the treatment method. The patients in the resection group were treated with synchronous resection of hepatopancreas lesions, the patients in the non-resection group were treated with conservative treatment including palliative bypass surgery, biliary drainage, systemic chemotherapy, and so on. The patients were followed up to December 2021. The overall survival of the patients in the two groups were compared, and the factors affecting the overall survival were analyzed. Results A total of 54 patients who met the inclusion and exclusion criteria were collected in this study, including 31 cases in the resection group and 23 cases in the non-resection group. There were no statistical differences between the two groups in the baseline data such as age, gender, preoperative liver function indexes,and so on(P>0.05). The pancreaticojejunostomy leakage occurred in 7 cases(22.6%) of the resection group. The median follow-up time of the resection group and the non-resection group were 14 and 11 months. The median overall survival time of patients in the resection group and non-resection group were 18.0 months [95%CI(13.8, 22.1)] and 12.0 months[95%CI(8.2, 15.8)] respectively. The survival of the resection group was better than that of the non-resection group by logrank test(χ~2=4.074, P=0.045). Cox multivariate regression analysis result showed that the preoperative low albumin level(≤35.0 g/L), no perioperative chemotherapy, and no synchronous resection of hepatopancreas lesions shortened the overall survival time of patients with hepatic oligometastatic pan

关 键 词：胰腺癌 肝寡转移 外科手术 预后 影响因素 

分 类 号：R735.9[医药卫生—肿瘤]