高危复发可切除胰腺癌新辅助治疗后机器人胰体尾癌根治术  

Robotic radical pancreatosplenectomy for high-risk recurrent resectable pancreatic cancer after neoadjuvant therapy

作　　者：张柯迪 潘立超[1] 张卓超 王斐[1] 尹注增[1] Zhang Kedi;Pan Lichao;Zhang Zhuochao;Wang Fei;Yin Zhuzeng(Faculty of Hepatopancreatobiliary Surgery,The First Medical Center of Chinese People's Liberation Army(PLA)General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心肝胆胰外科医学部,北京100853

出　　处：《中华腔镜外科杂志（电子版）》2023年第3期175-178,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的:探讨机器人胰体尾癌根治术治疗新辅助治疗后高危复发可切除胰腺癌的短期临床效果,总结手术技巧和要点。方法:回顾性分析解放军总医院第一医学中心肝胆胰外科医学部收治的1例患者病历资料。患者女性,52岁,体检发现胰尾肿瘤。CA19-9:1902 U/ml;MRI:胰尾少血供肿瘤,最大直径41 mm,考虑胰腺癌;PET-CT:胰尾高代谢肿块,SUVmax:7.1,考虑胰腺癌;胰胃间隙小淋巴结伴轻度代谢,转移可能。入院诊断胰尾癌(cT2N1M0,可切除,高危复发)。经吉西他滨、白蛋白紫杉醇联合PD-1抑制剂新辅助治疗4周期后,CA19-9降至272.6 U/ml,肿瘤直径缩小为26 mm,SUVmax降至2.8,胰胃间隙淋巴结代谢消失。RECIST评估为部分缓解,行机器人胰体尾癌根治联合部分胃壁切除术。结果:手术顺利完成,手术时间265 min,出血量100 ml,病理为中分化腺癌(pT2N0M0),术后11 d出院。术后行前述方案治疗2周期,随访18个月,无肿瘤复发及转移。结论:机器人胰体尾癌根治术治疗新辅助治疗后高危复发可切除胰腺癌安全可行。Objective:To investigate the short-term clinical effect of robotic radical pancreatosplenectomy for high-risk recurrent resectable pancreatic cancer after neoadjuvant therapy,summarize the technical aspects and key points,and discuss the recent clinical effects.Methods:The data of a patient treated in the Faculty of Hepatopancreatobiliary Surgery,The First Medical Center of Chinese People's Liberation Army(PLA)General Hospital were retrospectively analyzed.A 52-year-old female was diagnosed with pancreatic tail tumor.CA19-9 level was 1902 U/ml.MRI showed a hypovascular tumor in the pancreatic tail with the maximum diameter of 41mm.PET-CT showed a hypermetabolic mass in the pancreatic tail with SUVmax:7.1,and pancreatic cancer was considered.Small lymph nodes in the pancreaticogastric space with mild metabolism were suspected to metastasize.The patient was diagnosed with pancreatic tail cancer(cT2N1M0,resectable,high risk of recurrence).The patient was received 4 cycles of neoadjuvant therapy with gemcitabine,albumin-bound paclitaxel and PD-1 inhibitor.After treatment,CA19-9 level decreased to 272.6 U/ml,the maximum diameter of tumor decreased to 26 mm,SUVmax level decreased to 2.8,and the metabolism of lymph nodes in the pancreaticogastric space disappeared.RECIST criteria assessed a partial response.Robotic radical pancreatosplenectomy combined with partial gastric wall resection was performed.Results:The operation was completed successfully,and the operation time was 265 min and the blood loss was 100 ml.The pathological diagnosis was moderately differentiated adenocarcinoma(pT2N0M0).The patient was discharged 11 days after operation.After 2 cycles of treatment,there was no tumor recurrence or metastasis during the follow-up of 18 months.Conclusion:Robotic radical pancreatosplenectomy is safe and feasible in the treatment of high-risk recurrent pancreatic cancer after neoadjuvant therapy.

关 键 词：可切除胰腺癌 高危复发因素 机器人手术 胰脾切除术 

分 类 号：R735.9[医药卫生—肿瘤]