术前新辅助化疗联合个体化手术入路的腹腔镜胰十二指肠切除术在临界可切除胰头癌中的临床应用  

Clinical application of laparoscopic pancreaticoduodenectomy with preoperative neoadjuvant chemotherapy combined with individualized surgical approach in borderline resectable pancreatic head cancer

作　　者：刘少朋 闫宏宪 刘海潮 白明辉 程冰冰[2] LIU Shaopeng;YAN Hongxian;LIU Haichao;BAI Minghui;CHENG Bingbing(Hepatobiliary and Pancreatic Surgery,Luoyang Central Hospital Affiliated to Zhengzhou University,Luoyang,Henan 471000,P.R.China;Hepatobiliary and Pancreatic Surgery,The Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450007,P.R.China)

机构地区：[1]郑州大学附属洛阳中心医院肝胆胰外科,河南洛阳471000 [2]郑州大学第五附属医院肝胆胰腺外科,郑州450007

出　　处：《中国普外基础与临床杂志》2023年第8期931-938,共8页Chinese Journal of Bases and Clinics In General Surgery

基　　金：2021年河南省医学科技攻关计划联合共建项目(项目编号:LHGJ20210855);2021年河南省医学科技攻关计划省部共建重点项目(项目编号:SBGJ202102216);2021年河南省科学技术厅科技发展计划项目(项目编号:212102310676)。

摘　　要：目的探讨术前新辅助化疗(neoadjuvant chemotherapy,NAC)联合多种手术入路的腹腔镜胰十二指肠切除术(laparoscopic pancreatoduodenectomy,LPD)在临界可切除胰头癌中的临床应用价值。方法回顾性分析2017年1月至2022年6月期间郑州大学附属洛阳中心医院肝胆胰外科及郑州大学第五附属医院肝胆胰腺外科收治的35例临界可切除胰头癌患者的临床病理资料。所有患者术前均行NAC(AG方案),疗程结束后依据临界可切除胰腺癌(borderline resectable pancreatic cancer,BRPC)分型[静脉受侵型(BRPC-V型)和动脉受侵型(BRPC-A型)]采取个体化手术入路行LPD(BRPC-V型:肠系膜下静脉入路;BRPC-A型:左后方入路、钩突内侧入路、前入路或结肠系膜下方入路)。记录患者术中情况、R0/R1切除率、淋巴结清扫、术后并发症、术后住院时间、恢复情况、随访及生存情况。结果(1)NAC疗效评估:4周疗程结束后,部分缓解13例,病情稳定17例,病情进展5例;5例病情进展患者继续接受内科综合治疗,余30例患者行LPD。(2)术中情况:30例患者顺利完成LPD术,其中2例行联合肠系膜上静脉(或)门静脉切除重建的扩大胰十二指肠切除术。30例LPD患者中,肠系膜下静脉入路10例,左后方入路10例,钩突内侧入路6例,左后方入路+钩突内侧入路1例,前入路2例,结肠系膜下方入路1例。手术时间为(379.4±77.3)min,术中出血量为(436.9±95.1)mL。(3)术后情况:手术相关性并发症发生率为33.3%(10/30),其中Clavien-Dindo分级Ⅰ级4例[胆瘘1例(3.3%),A级胰瘘1例(3.3%),胃排空功能障碍1例(3.3%),腹泻1例(3.3%)],Ⅱ级5例[肺部感染2例(6.6%),B级胰瘘2例(6.6%),腹腔感染1例(3.3%)],Ⅲ级1例[胃十二指肠动脉残端出血(3.3%)]。10例发生并发症患者中,9例经对症治疗后好转恢复,1例死亡,病死率为3.3%(1/30)。术后住院时间为(17.3±5.5)d。(4)切除率及病理结果:10例BRPC-V型LPD患者R0切除率为90.0%(9/10),1例患者R1切除;2Objective To explore the clinical value of preoperative neoadjuvant chemotherapy(NAC)combined with laparoscopic pancreatoduodenectomy(LPD)with multiple surgical approaches in the treatment of borderline resectable pancreatic head cancer.Methods The clinicopathologic data of 35 patients with critical resectable pancreatic head carcinoma admitted to the Department of Hepatobiliary and Pancreatic Surgery of Luoyang Central Hospital Affiliated to Zhengzhou University and the Department of Hepatobiliary and Pancreatic Surgery of the Fifth Affiliated Hospital of Zhengzhou University from January 2017 to June 2022 were retrospectively analyzed.All patients received NAC before operation(AG protocol).At the end of the course of treatment,according to the type of borderline resectable pancreatic cancer(BRPC)[venous invasion type(BRPC-V type)and arterial invasion type(BRPC-A type)],take the individualized surgical approach for LPD(BRPC-V type:inferior mesenteric vein approach;BRPC-A type:left posterior approach,medial uncinate process approach,anterior approach,or lower mesocolon approach).The intraoperative condition,R0/R1 resection rate,lymph node dissection,postoperative complications,average hospital stay,recovery,follow-up and survival were recorded.Results①Efficacy evaluation of NAC:13 patients were partially relieved,17 patients were stable and 5 patients were progressive after 4 weeks of treatment.Five progressive patients continued to receive comprehensive internal medicine treatment,and the remaining 30 patients underwent LPD.②Intraoperative situation:LPD were successfully completed in 30 patients,2 patients underwent extended pancreaticoduodenectomy combined with superior mesenteric vein(or)portal vein reconstruction among them.Among the 30 patients with LPD,there were 10 cases of inferior mesenteric vein approach,10 cases of left posterior approach,6 cases of medial uncinate process approach,1 case of left posterior approach+medial uncinate process approach,2 cases of anterior approach,and 1 case of inferior

关 键 词：临界可切除胰头癌 胰十二指肠切除术 新辅助化疗 手术入路 

分 类 号：R735.9[医药卫生—肿瘤]