经肠系膜下静脉入路横断胰腺体部在联合静脉切除的胰十二指肠切除术中的应用:多中心历史性队列研究  

Utility of transecting pancreatic body via inferior mesenteric vein pathway during pancreaticoduodenectomy with venous resection:a multicenter historical cohort study

作　　者：任浩源[1,2] 麦刚 柯能文[2] 刘续宝[2] REN Haoyuan;MAI Gang;KE engwen;LIU Xubao(Department of Gastrointestinal Surgery,People's Hospital of Deyang,Deyang,Sichuan 618000,P.R.China;Department of Pancreatic Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]德阳市人民医院胃肠外科,四川德阳618000 [2]四川大学华西医院胰腺外科,都610041

出　　处：《中国普外基础与临床杂志》2023年第4期420-425,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川大学华西医院学科发展“135”工程特色专病/专项技术项目(项目编号:ZY2017302 1-3-5)。

摘　　要：目的 探讨经肠系膜下静脉(inferior mesenteric vein,IMV)途径横断胰腺体部的手术入路方式在联合静脉切除的胰十二指肠切除术(pancreaticoduodenectomy,PD)中的应用效果。方法 根据纳入和排除标准,回顾性收集2016年2月1日至2021年1月1日期间四川大学华西医院胰腺外科行PD联合门静脉(portal vein,PV)/肠系膜上静脉(superior mesenteric vein,SMV)切除的胰腺癌患者,将它根据能否采取传统入路在PV/SMV血管轴前建立隧道分为传统入路组和改良入路组,在改良入路组中患者经IMV途径横断胰腺体部者划为IMV亚组,经PV左侧或胰腺中央横断胰腺体部者划为中央亚组,比较改良入路组同传统入路组以及IMV亚组同传统入路组和中央亚组在临床病理特征及生存(总生存期)方面的差异;使用Kaplan-Meier法绘制生存曲线进行生存分析,同时采用Cox比例风险回归模型进行多因素分析影响总生存期的风险因素。结果 本研究共纳入142患者,其中传统入路组77例,改良入路组65例,IMV亚组29例、中央亚组36例。与传统入路组比较,改良入路组术中失血量增加(P<0.001)、术后总住院时间延长(P=0.021)及有血管侵犯者占比更高(P=0.017),而IMV亚组较之仅在有血管侵犯者占比上更高(P=0.030);而IMV亚组较中央亚组术中失血量更少(P<0.001)及R0占比更高(P=0.031)。其他临床病理资料在各组间比较差异均未见有统计学意义(P>0.05)。根据Kaplan-Meier法绘制的生存曲线,IMV亚组、中央亚组及传统入路组的中位总生存期分别为21、17及22个月,IMV亚组的总生存情况优于中央亚组(χ^(2)=4.676,P=0.031),而IMV亚组与传统入路组的总生存期曲线比较差异无统计学意义(χ^(2)=0.007,P=0.934)。多因素分析结果发现,术后实施辅助化学药物治疗[RR=0.519,95%CI(0.324,0.833),P=0.007]和R0切缘[RR=0.434,95%CI(0.218,0.865),P=0.018]是影响患者总生存期的保护因素,肿瘤低分化[RR=2.433,95%CI(1.587,3.730),Objective To evaluate the effect of transecting the body of pancreas via inferior mesenteric vein(IMV)pathway during pancreaticoduodenectomy(PD)with venous resection.Methods According to the inclusion and exclusion criteria,from February 1,2016 to January 1,2021,the patients who underwent PD with portal vein/superior mesenteric vein(PV/SMV)resection for resectable pancreatic adenocarcinoma were gathered.According to whether the traditional approach could be adopted to create a tunnel in front of the PV/SMV axis,the patients were allocated to the standard procedure group(S-group)or a modified procedure group(M-group).In the M-group,the patients who transected the pancreatic body via IMV pathway were allocated to the IMV-subgroup,while the patients who transected the pancreatic body via the left side of PV or in the middle of the pancreas were allocated to the central subgroup(C-subgroup).The clinicopathologic characteristics and survival(overall survival)were compared between the M-group and S-group,as well as between the IMV-subgroup and C-subgroup.The survival curve was drawn using Kaplan-Meier method for survival analysis,and the risk factors affecting overall survival by Cox proportional hazards regression model.Results A total of 142 patients were gathered,including 77 in the S-group,65 in the M-group,29 in the IMV-subgroup and36 in the C-subgroup.The results of clinicopathologic data of patients among the different groups showed that the M-group had a more intraoperative bleeding(P0.001),longer postoperative hospital stay(P=0.021),and a proportion of vascular invasion(P=0.017),as well as the IMV-subgroup only had a higher proportion of vascular invasion(P=0.030)as compared with the S-group;At the same time,compared with the C-subgroup,the IMV-subgroup had a less intraoperative bleeding volume(P0.001)and a higher proportion of R0 resection(P=0.031).There were no statistically differences in other clinicopathologic data among the groups(P0.05).The analysis of survival curve by Kaplan-Meier method showed that t

关 键 词：胰腺癌 胰十二指肠切除术 静脉切除 

分 类 号：R735.9[医药卫生—肿瘤]