胰腺癌新辅助转化治疗后根治性切除术的临床疗效  

Clinical efficacy of radical resection of pancreatic cancer after neoadjuvant conversion therapy

作　　者：朱琳熙 毛谅[1] 杜娟[2] 孔炜伟[2] 王雷[3] 吕瑛[3] 何健[4] 唐敏[5] 陈骏[6] 仇毓东[1] Zhu Linxi;Mao Liang;Du Juan;Kong Weiwei;Wang Lei;Lyu Ying;He Jian;Tang Min;Chen Jun;Qiu Yudong(Department of Biliary and Pancreatic Surgery,Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210008,China;Department of Oncology,Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210008,China;Department of Gastroenterology,Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210008,China;Department of Nuclear Medicine,Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210008,China;Department of Radiology,Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210008,China;Department of Pathology,Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院胆胰外科,南京210008 [2]南京大学医学院附属鼓楼医院肿瘤科,南京210008 [3]南京大学医学院附属鼓楼医院消化科,南京210008 [4]南京大学医学院附属鼓楼医院核医学科,南京210008 [5]南京大学医学院附属鼓楼医院放射科,南京210008 [6]南京大学医学院附属鼓楼医院病理科,南京210008

出　　处：《中华消化外科杂志》2023年第7期916-923,共8页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(31971518);科技部重点研发计划(2020YFA0713800);江苏省科技厅重点项目(ZD2021017)。

摘　　要：目的探讨胰腺癌新辅助转化治疗后行根治性切除术的临床疗效。方法采用回顾性描述性研究方法。收集2019年1月至2022年5月南京大学医学院附属鼓楼医院收治的23例接受新辅助转化治疗后根治性切除术胰腺癌患者的临床病理资料;男17例,女6例;年龄为58(33~73)岁。患者行新辅助转化治疗后,采用3D可视化技术对肿瘤血管侵犯情况进行评估和分型,规划手术方案并实施手术。观察指标:(1)新辅助转化治疗情况。(2)手术情况。(3)术后组织病理学检查情况。(4)术后恢复情况。(5)随访情况。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)或M(Q1,Q3)表示。计数资料以绝对数表示。结果(1)新辅助转化治疗情况。23例患者均接受AG方案(白蛋白结合型紫杉醇+吉西他滨)化疗,其中14例联合立体定向放疗(SBRT)。23例患者新辅助转化治疗后部分缓解22例,疾病稳定1例。23例患者新辅助转化治疗前和治疗后CA19⁃9分别为85.06(29.74,634.50)U/mL和13.96(9.74,25.02)U/mL。(2)手术情况。23例患者术前被评估为动脉侵犯型胰腺癌7例、静脉侵犯型胰腺癌8例、动静脉侵犯型胰腺癌5例,未发现血管侵犯3例。23例患者中,12例行胰十二指肠切除术,4例行根治性顺行模块化胰脾切除术,7例行全胰十二指肠切除术;未进行血管重建10例,进行人工血管静脉重建13例。23例患者手术时间为(524±171)min,术中出血量为1000(400,1600)mL。(3)术后组织病理学检查情况。23例患者术后组织病理学检查:中⁃高分化2例,中分化10例,中⁃低分化7例,低分化2例,无瘤状态2例;淋巴结清扫数目为(16±7)枚,伴淋巴结转移5例,无淋巴结转移18例;伴神经侵犯17例,无神经侵犯6例;23例均无脉管侵犯。23例患者中,21例R0切除,2例R1切除。病理学TNM分期:0期2例,Ⅰ期13例,Ⅱ期7例,Ⅳ期1例。术后病理学评分:0分2例(完全缓解),2分16例(部分缓解),3分5例(效Objective To investigate the clinical efficacy of radical resection of pancreatic cancer after neoadjuvant conversion therapy.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 23 patients who underwent radical resection of pancreatic cancer after neoadjuvant conversion therapy in Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School from January 2019 to May 2022 were collected.There were 17 males and 6 females,aged 58(range,33−73)years.After neoadjuvant conversion therapy,the three-dimensional(3D)visualization was used to evaluate and classify tumor vascular invasion,and surgical plan was planned and implemented.Observation indicators:(1)situations of neoadjuvant conversion therapy;(2)surgical situations;(3)postoperative histopathological examination;(4)postoperative recovery;(5)follow-up.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(range)or M(Q1,Q3).Count data were described as absolute numbers.Results(1)Situations of neoadjuvant conversion therapy.All 23 patients received the AG combination chemotherapy(albumin-paclitaxel+gemcitabine),including 14 patients combined with stereotactic body radiation therapy.Of the 23 patients,22 cases achieved partial response,and 1 case showed stable disease.The CA19-9 of the 23 patients was 85.06(29.74,634.5)U/mL and 13.96(9.74,25.02)U/mL before and after neoadjuvant conversion therapy,respectively.(2)Surgical situations.According to the results of preoperative 3D visualization of tumor vascular invasion,7 of the 23 patients were evaluated as arterial invasion,8 cases were evaluated as venous invasion,5 cases were evaluated as arterial and venous invasion,and there were 3 cases showing negative of vascular invasion.Of the 23 patients,12 cases underwent pancreaticoduodenectomy,4 cases underwent radical antegrade modular pancreatosplenectomy,7 cases underwent total pancreaticoduodenectomy.For vascular reconstruction,ther

关 键 词：胰腺肿瘤 新辅助转化治疗 3D可视化 血管切除重建 动脉鞘剥除 

分 类 号：R735.9[医药卫生—肿瘤]