联合腹腔干切除的胰体尾癌根治术治疗胰颈体癌的单中心回顾性分析  

Distal pancreatectomy with celiac axis resection for pancreatic body cancer: a single center review of 89 consecutive cases

作　　者：黄徐敏 张凯 尹杰 吴鹏飞 蔡宝宝 陆子鹏 涂敏 陈建敏 郭峰 奚春华 卫积书 吴峻立 高文涛 戴存才 苗毅 蒋奎荣 Huang Xumin;Zhang Kai;Yin Jie;Wu Pengfei;Cai Baobao;Lu Zipeng;Tu Min;Chen Jianmin;Guo Feng;Xi Chunhua;Wei Jishu;Wu Junli;Gao Wentao;Dai Cuncai;Miao Yi;Jiang Kuirong(Pancreas Center,First Affiliated Hospital of Nanjing Medical University,Pancreas Institute,Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院胰腺中心、南京医科大学胰腺研究所,南京210029

出　　处：《中华外科杂志》2023年第10期894-900,共7页Chinese Journal of Surgery

摘　　要：目的探讨联合腹腔干切除的胰体尾癌根治术(DP-CAR)治疗胰腺颈体癌的临床效果。方法回顾性分析2013年9月至2022年6月南京医科大学第一附属医院胰腺中心连续收治的89例因胰腺颈体癌行DP-CAR治疗的患者资料。男性50例, 女性39例;年龄[M(IQR)]63(12)岁(范围:43~81岁)。分类资料采用χ^(2)检验或Fisher确切概率法分析, 定量资料以秩和检验分析, 以Kaplan-Meier法绘制生存曲线并估计中位生存时间。结果 89例DP-CAR中, 联合门静脉-肠系膜上静脉切除重建20例(22.5%)、联合器官切除38例(42.7%);手术时间270(110)min(范围:143~530 min), 术中出血量300(300)ml(范围:50~2 500 ml), 术后住院时间13(10)d(范围:7~101 d)。总体并发症发生率为67.4%(60/89), 其中Clavien-Dindo并发症分级系统≥Ⅲ级10例(11.2%), 术后出现一过性肝脏转氨酶升高38例(42.7%)、肝功能衰竭3例(3.4%)、B级和C级胰瘘48例(53.9%)、胆瘘1例(1.1%)、B级和C级乳糜瘘3例(3.4%)、腹腔感染10例(11.2%)、B级和C级术后出血8例(9.0%)、胃排空延迟4例(4.5%)、深静脉血栓形成6例(6.7%), 再手术3例(3.4%)。住院期间死亡4例(4.5%), 术后90 d内死亡7例(7.9%)。89例均为胰腺癌, 其中胰腺导管腺癌占92.1%(82/89);肿瘤最大径4.8(2.0)cm(范围:1.5~12.0 cm), 共清扫淋巴结14(13)枚(范围:2~33枚), 淋巴结阳性率为13.0%(24.0%);R0切除率为30.0%(24/80)、R1(<1 mm)切除率为58.8%(47/80);术后中位生存时间为21.3个月(95%CI:15.6~24.3个月), 中位无病生存时间为19.1个月(95%CI:11.7~25.1个月), 术后1年总体生存率为69.60%, 术后2年总体生存率为39.52%。58例术后行辅助化疗者的中位生存时间为24.3个月(95%CI:17.8~32.3个月), 13例术后未行化疗或其他辅助治疗者的中位生存时间为8.4个月(95%CI:7.3~22.3个月);7例患者于术前行新辅助化疗, 无Clavien-Dindo并发症分级系统Ⅲ级以上并发症发生, R0切除率为5/7。结论对选择性的胰腺颈体癌病例, 联合�Objective To investigate the clinical efficacy of distal pancreatectomy with celiac axis resection(DP-CAR).Methods A total of 89 consecutive patients(50 males and 39 females)who were diagnosed with pancreatic body cancer and underwent DP-CAR in Pancreas Center,First Affiliated Hospital of Nanjing Medical University between September 2013 and June 2022 were retrospectively reviewed.There were 50 males and 39 females,with age(M(IQR))of 63(12)years(range:43 to 81 years).Perioperative parameters,pathology results and follow-up data of these patients were analyzed,χ^(2) or Fisher′s test for categorical data while the Wilcoxon test for quantitative data.Survival results were estimated by the Kaplan-Meier survival method.Results Among 89 cases,cases combined with portal vein-superior mesenteric vein or organ resection accounted for 22.5%(20/89)and 42.7%(38/89),respectively.The operative time,blood loss and postoperative hospital stay were 270(110)minutes,300(300)ml and 13(10)days,respectively.The overall morbidity rate was 67.4%(60/89)while the major morbidity was 11.2%(10/89).The increase rate in transient liver enzymes was 42.7%(38/89),3.4%(3/89)for liver failure,53.9%(48/89)for clinically relevant postoperative pancreatic fistula,1.1%(1/89)for bile leak,3.4%(3/89)for chylous leak of grade B and C,11.2%(10/89)for abdominal infection,9.0%(8/89)for postoperative hemorrhage of grade B and C,4.5%(4/89)for delayed gastric emptying,6.7%(6/89)for deep vein thrombosis,3.4%(3/89)for reoperation,4.5%(4/89)for hospital mortality,7.9%(7/89)for 90-day mortality.The pathological type was pancreatic cancer for all 89 cases and pancreatic ductal adenocarcinoma made up 92.1%(82/89).The tumor size was 4.8(2.0)cm,ranging from 1.5 to 12.0 cm.The number of lymph nodes harvested was 14(13)(range:2 to 33),with a positive lymph node rate of 13.0%(24.0%).The resection R0 rate was 30.0%(24/80)and the R1(<1 mm)rate was 58.8%(47/80).The median overall survival time was 21.3 months(95%CI:15.6 to 24.3)and the median disease-free survival time w

关 键 词：胰腺肿瘤 外科手术 交界可切除胰腺癌 联合腹腔干切除的胰体尾癌根治术 改良Appleby手术 

分 类 号：R735.9[医药卫生—肿瘤]