根治性顺行模块化胰脾切除术在胰体尾部癌中的应用(多中心研究)  

Application of radical antegrade modular pancreatosplenectomy for carcinoma of pancreatic body and tail:A multicenter study

作　　者：王进峰 邓顺 贺卓 肖科 吕品[2] 马铁祥 费书珂 刘卓 徐彪铭 王双 罗建红 欧阳永忠 谢江波 郑金海 李清龙[5] 左朝晖 WANG Jinfeng;DENG Shun;HE Zhuo;XIAO Ke;LYU Pin;MA Tiexiang;FEI Shuke;LIU Zhuo;XU Biaoming;WANG Shuang;LUO Jianhong;OUYANG Yongzhong;XIE Jiangbo;ZHENG Jinhai;LI Qinglong;ZUO Chaohui(Department of Gastroduodenal and Pancreatic Surgery,the Affiliated Cancer Hospital of Xiangya School Medicine&Hunan Cancer Hospital,Central South University,Changsha 410013,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Hunan Normal University&Hunan Provincial People’s Hospital,Changsha 410005,China;the Third Department of General Surgery,Xiangtan Central Hospital,Hunan 411100,China;Department of Hepatobiliary,Pancreatic and Splenic Surgery,the Second Affiliated Hospital of University of South China,Hengyang,Hunan 421001,China;Department of General Surgery,the Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅医学院附属肿瘤医院/湖南省肿瘤医院胃十二指肠胰腺外科,湖南长沙410013 [2]湖南师范大学附属第一医院/湖南省人民医院肝胆外科,湖南长沙410005 [3]湘潭市中心医院普通三外科,湖南湘潭411100 [4]南华大学附属第二医院肝胆胰脾外科,湖南衡阳410001 [5]中南大学湘雅二医院普通外科,湖南长沙410011

出　　处：《肝胆胰外科杂志》2023年第3期140-145,共6页Journal of Hepatopancreatobiliary Surgery

基　　金：湖南省自然科学基金项目(2020JJ4053)。

摘　　要：目的 探讨根治性顺行模块化胰脾切除术(RAMPS)在胰体尾部癌中应用的安全性和疗效。方法 回顾性分析2010年1月至2019年12月湖南省肿瘤医院、湖南省人民医院、中南大学湘雅二医院、湘潭市中心医院和南华大学附属第二医院收治的122例胰体尾部癌RAMPS术临床资料,总结分析RAMPS手术安全性和疗效。结果 122例患者均接受RAMPS术治疗,术后并发症发生率为28.69%(35/122),其中包括胰瘘19例(15.57%,B级14例,C级5例),单纯腹腔感染5例(4.10%),肺部感染3例(2.46%),胃排空延迟3例(2.46%),肠瘘2例(1.64%),术后出血3例(2.46%,腹腔术野出血2例,消化道出血1例)。术后26d出现严重并发症死亡2例(1.64%)。余120例患者中,1、3和5年术后复发率分别为25.00%、59.17%和85.00%,局部复发转移率、肝转移率和肺转移率分别为33.33%(40/120)、21.67%(26/120)和18.33%(22/120)。所有122例患者的1、3、5年总体生存率分别为63.51%、42.25%和22.55%。单因素Cox回归分析显示,患者术后生存率与肿瘤大小、淋巴结转移、TNM分期、围手术期输血量和肿瘤分化程度有关(P<0.05);多因素Cox回归分析显示,患者术后生存率独立危险因素包括肿瘤大小、淋巴结转移和围手术期输血量(P<0.05)。结论 胰体尾部癌行RAMPS手术在临床上证实是有效的,手术安全可行,可提高胰体尾部癌淋巴结清扫数量和根治性切除率。肿瘤大小、淋巴结转移和围手术期输血量是影响胰体尾部癌患者RAMPS手术预后的独立危险因素。Objective To explore the safety and efficacy of radical antegrade modular pancreatosplenectomy(RAMPS)for carcinoma of pancreatic body and tail.Methods The clinical data of 122 patients who received RAMPS in Hunan Cancer Hospital,Hunan Provincial People’s Hospital,the Second Xiangya Hospital of Central South University,Xiangtan Central Hospital,and the Second Affiliated Hospital of University of South China between Jan.2010 and Dec.2019 was analyzed retrospectively.Results Of 122 cases with RAMPS,the incidence rate of postoperative complications was 28.69%(35/122),including pancreatic fistula in 19 cases(15.57%,14 cases with grade B,5 cases with grade C),intra-abdominal infection in 5 cases(4.10%),pulmonary infection in 3 cases(2.46%),delayed gastric emptying in 3 cases(2.46%),intestinal fistula in 2 cases(1.64%),postoperative bleeding in 3 cases(2.46%,2 cases with intraperitoneal hemorrhage,1 case with digestive bleeding).There were 2 deaths for severe postoperative complications in 26 d(1.64%).Of the remaining 120 cases,1-,3-and 5-year postoperative recurrence rates were 25.00%,59.17%,and 85.00%,respectively.The rates of local recurrence,liver and lung metastasis were 33.33%(40/120),21.67%(26/120)and 18.33%(22/120),respectively.For all 122 patients,1-,3-and 5-year postoperative overall survival rates were 63.51%,42.25%and 22.55%,respectively.Univariate analysis showed that the survival rates after RAMPS were related with tumor size,lymph node metastasis,TNM staging,perioperative blood transfusions and degree of tumor differentiation(P<0.05).Multivariate analysis showed that tumor size,lymph node metastasis and perioperative blood transfusions were independent risk factors for survival rates(P<0.05).Conclusion RAMPS is clinically proved effective,safe and feasible for carcinoma of pancreatic body and tail,which can improve the number of lymph node dissection and the rate of radical resection.Tumor size,lymph node metastasis and perioperative blood transfusions were independent risk factors for postoperative sur

关 键 词：胰体尾部癌 根治性顺行模块化胰脾切除术 临床疗效 肿瘤大小 淋巴结转移 围手术期输血 预后 

分 类 号：R735.9[医药卫生—肿瘤]