胰头癌根治术中淋巴结清扫范围的研究进展  

The progression of the extent of lymph node dissection in radical resection of pancreatic head cancer

作　　者：陈佳浩 姜翀弋 Chen Jiahao;Jiang Chongyi(Department of General Surgery,Huadong Hospital Affiliated to Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华东医院普外科,上海200040

出　　处：《中华外科杂志》2023年第3期251-255,共6页Chinese Journal of Surgery

基　　金：上海市科学技术委员会医学创新专项项目(20Y11908600);上海市卫生健康委员会课题(20194Y0195)。

摘　　要：胰腺癌是预后极差的消化系统恶性肿瘤,手术切除是胰腺癌患者获得根治的唯一希望。虽然目前各共识和指南详细描述了胰头癌根治术标准和扩大淋巴结清扫的范围,但对于具体的淋巴结清扫范围对预后的影响仍有争议。目前研究者不但提出了一些改良的淋巴结清扫范围,如胰腺全系膜切除和海德堡三角清扫,且建议对腹侧和背侧胰头癌选择不同的淋巴结清扫范围。此外,在清扫主动脉旁淋巴结后,钩突部和非钩突部胰头癌患者的预后有所不同,值得进一步研究。新辅助治疗和转化治疗为胰腺癌患者提供了更多的手术机会,海德堡三角清扫对于改善这些胰腺癌患者的预后有潜在价值。本文总结了近年来标准和扩大淋巴结清扫、特定部位胰头癌的淋巴结清扫及新辅助治疗或转化治疗后淋巴结清扫范围等问题的探索与最新进展。Pancreatic cancer is a malignant tumor of digestive system with poor prognosis,and surgical resection is still the only hope for a radical cure.Although the current consensus and guidelines describe in detail the standard and extended range of lymph node dissection,the selection of specific range of lymph node dissection and its impact on prognosis are still controversial.Current studies have not only proposed some improved extent of lymph node dissection,such as total mesopancreas excision and Heidelberg triangle dissection,but also suggested different extent of lymph node dissection for ventral and dorsal pancreatic head cancer.In addition,the prognosis of pancreatic head cancer in uncinate process and non-uncinate process is different after para-aortic lymph node dissection,which is worthy of further study.Neoadjuvant therapy or conversion therapy provides more surgical opportunities for patients with pancreatic cancer.For these patients,Heidelberg triangle dissection has potential value in improving prognosis.This paper summarizes the exploration and latest progress of standard and extended lymph node dissection,lymph node dissection of specific site of pancreatic head cancer and the extent of lymph node dissection after neoadjuvant/transformation therapy in recent years.

关 键 词：胰腺肿瘤 淋巴结切除术 新辅助治疗 预后 

分 类 号：R735.9[医药卫生—肿瘤]