腹腔镜胰十二指肠切除术中第14c/d组淋巴结清扫在胰头癌中的临床效果研究  

Clinical effect of 14c/d group lymph node dissection during laparoscopic pancreaticoduodenectomy in patients withpancreaticheadcancer

作　　者：史成宇 季晓琳 田莉莹 张来香 Shi Chengyu;Ji Xiaolin;Tian Liying;Zhang Laixiang(Department of Hepatobiliary Surgery,University of Health and Rehabilitation Sciences(Qingdao Central Hospital),Qingdao Shandong Province 266042,China;Department of Tumor Stereotactic Radiotherapy,University of Health and Rehabilitation Sciences(Qingdao Central Hospital),Qingdao Shandong Province 266042,China;Institute of Pulmonary Disease,University of Health and Rehabilitation Sciences(Qingdao Central Hospital),Qingdao Shandong Province 266042,China;Department of Hepatobiliary and Vascular Surgery,Qingdao Central Hospital,University of Health and Rehabilitation Sciences(Qingdao Central Hospital),Qingdao Shandong Province 266042,China)

机构地区：[1]康复大学青岛中心医院(青岛市中心医院)肝胆外科,山东青岛266042 [2]康复大学青岛中心医院(青岛市中心医院)肿瘤立体定向放疗科,山东青岛266042 [3]康复大学青岛中心医院(青岛市中心医院)肺病研究所,山东青岛266042 [4]康复大学青岛中心医院(青岛市中心医院)肝胆血管外科,山东青岛266042

出　　处：《中华普外科手术学杂志（电子版）》2024年第4期430-433,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的研究腹腔镜胰十二指肠切除术(LPD)中第14c/d组淋巴结清扫在胰头癌中的临床效果。方法回顾性分析2019年9月至2023年9月行LPD的46例胰头癌患者的临床资料,根据术中是否对第14c/d组淋巴结进行清扫分为清扫组(n=24例)和未清扫组(n=22例)。未清扫组参照《中国胰腺癌诊治指南(2021)》行标准淋巴结清扫范围的LPD;清扫组在未清扫组的基础上清扫第14c/d组淋巴结。采用SPSS25.0统计学软件分析数据。并发症等计数资料用[例(%)]表示,行x或秩和检验;手术相关指标等计量资料用(x±s)表示,组间比较行独立样本t检验;使用Kaplan-Meier法绘制生存曲线,行Log-Rank检验。P<0.05为差异有统计学意义。结果清扫组和未清扫组患者在手术时间、出血量、胃肠功能恢复时间及术后住院时间上比较差异均无统计学意义(P>0.05);清扫组患者清扫淋巴结枚数、检出阳性淋巴结枚数及R0切除率均显著高于未清扫组(P<0.05);清扫组患者术后并发症总发生率虽高于未清扫组(37.5%Us.27.3%),但差异未见统计学意义(P>0.05);清扫组患者较未清扫组的累积总生存率(70.8%us.59.1%)和无病生存率(62.5%us.50.0%)均显著升高(Log-RankX=4.172、4.023,P=0.041、0.045)。结论LPD中第14c/d组淋巴结清扫在胰头癌中是安全、可行的,在不显著增加术后并发症的同时,可使淋巴结清扫更彻底,提高了肿瘤的根治性,并改善了患者的预后。Objective To investigate the clinical effect of laparoscopic pancreaticoduodenectomy(LPD)in the treatment of pancreatic head cancer with lymph node dissection in group 14c/d.MethodsThe clinical data of 46 patients with pancreatic head cancer who underwent LPD from September 2019 to September 2023 were retrospectively analyzed.According to whether lymph nodes in group 14c/d were dissected during operation,they were divided into the dissected group(n=24 cases)and the undissected group(n=22 cases).In the non-dissected group,LPD in the standard lymph node dissection range was performed according to the Chinese Guidelines for Diagnosis and Treatment of Pancreatic Cancer(2021).Lymph nodes of group 14c/d were cleaned in the cleaning group on the basis of the non-cleaning group.SPSS 25.0 statistical software was used to analyze the data.The statistical data of complications were expressed by[cases(%)]and X or Rank Sum test was performed.Measurement data such as surgery-related indicators were represented by(x±s),and independent sample t test was performed for inter-group comparison.The survival curve was drawn by Kaplan-Meier method and tested by Log-Rank.P<0.05 was considered statistically significant.ResultsThere were no significant differences in operation time,blood loss,gastrointestinal function recovery time and postoperative hospital stay between the two groups(P>0.05).The number of lymph nodes cleared,the number of positive lymph nodes detected and the RO resection rate in the dissection group were significantly higher than those in the non-dissection group(P<0.05).The total incidence of postoperative complications in the sweeping group was higher than that in the non-sweeping group(37.5%us.27.3%),but the difference was not statistically significant(P>0.05).The cumulative overall survival rate(70.8%vs.59.1%)and diseasefree survival rate(62.5%us.50.0%)in the swept group were significantly higher than those in the non-swept group(Log-Rank x^(2)=4.172,4.023,P=0.041,0.045).Conclusion Lymph node dissection in group 1

关 键 词：胰腺肿瘤 腹腔镜 胰十二指肠切除术 淋巴结切除术 

分 类 号：R735.9[医药卫生—肿瘤]