全胰切除术与胰十二指肠切除术治疗胰腺癌的手术疗效和生活质量对比分析:基于倾向性评分匹配的回顾性队列研究  

Surgical Efficacy and Quality of Life of Total Pancreatectomy versus Pancreatico-duodenectomy for Pancreatic Cancer:A Retrospective Cohort Study Based on Propensity Score Matching

作　　者：李天宇 赵邦博 李泽儒 赵宇彤 韩显林[2] 张太平[2] 戴梦华[2] 郭俊超[2] 王维斌[2] LI Tianyu;ZHAO Bangbo;LI Zeru;ZHAO Yutong;HAN Xianlin;ZHANG Taiping;DAI Menghua;GUO Junchao;WANG Weibin(Graduate School,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100005,China;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院研究生院,北京100005 [2]中国医学科学院北京协和医院基本外科,北京100730

出　　处：《协和医学杂志》2024年第4期807-818,共12页Medical Journal of Peking Union Medical College Hospital

基　　金：中央高水平医院临床科研专项(2022-PUMCH-B-004)。

摘　　要：目的探究全胰切除术(total pancreatectomy,TP)与胰十二指肠切除术(pancreaticoduodenectomy,PD)治疗胰腺癌患者的术后短期并发症与长期预后差异。方法回顾性收集北京协和医院2016年1月至2021年12月行TP(TP组)和2019年1月至2021年12月行PD(PD组)的胰腺癌患者临床资料。根据危险因素的不同,将PD组患者分为胰瘘高风险PD组和复发高风险PD组。采用倾向性评分法匹配后,比较TP组与胰瘘高风险PD组、复发高风险PD组术后短期手术疗效指标(术后并发症发生率、30 d死亡率、住院时间等)、长期手术疗效指标(总生存期)及生活质量差异。结果共入选符合纳入与排除标准的TP组患者32例,PD组174例(胰瘘高风险PD组99例,复发高风险PD组15例)。(1)TP组与胰瘘高风险PD组:经倾向性评分匹配后,最终纳入TP组患者29例、胰瘘高风险PD组患者56例。TP组无胰瘘发生,胰瘘高风险PD组胰瘘发生率为19.64%(P=0.027),两组其他术后并发症发生率、Clavien-Dindo分级、住院时间、ICU停留时间、30 d死亡率等短期手术疗效指标均无统计学差异(P均>0.05)。中位随访时间36个月时,两组生命质量核心量表(quality of life questionnaire-core 30,QLQ-C30)评分均无显著差异(P均>0.05)。(2)TP组与复发高风险PD组:由于两组基线资料均无统计学差异(P均>0.05),故TP组32例患者、复发高风险PD组15例患者均纳入分析。TP组无胰瘘发生,复发高风险PD组胰瘘发生率为20.00%(P=0.028),两组其他术后并发症发生率、Clavien-Dindo分级、住院时间、ICU停留时间、30 d死亡率等短期手术疗效指标亦无统计学差异(P均>0.05)。截至末次随访,与复发高风险PD组比较,TP组中位总生存期更长(37.68个月比15.24个月,HR=2.551,95%CI:1.144~5.689,P=0.018);多因素Cox回归分析显示,复发高风险PD、术前合并梗阻性黄疸是胰腺癌患者长期预后不良的独立危险因素。结论对于胰瘘高风险胰腺癌患者,TP可取得�Objective To investigate the differences in postoperative short-term complications and long-term prognosis of pancreatic cancer(PC)patients after total pancreatectomy(TP)and pancreaticoduodenec-tomy(PD).Methods Clinical data of PC patients who underwent TP from January 2016 to December 2021(TP group)and PD from January 2019 to December 2021(PD group)at Peking Union Medical College Hos-pital were retrospectively collected.Patients in the PD group were divided into the pancreatic fistula(PF)high-risk PD group and the recurrence high-risk PD group according to risk factors.After propensity score matc-hing,the differences in postoperative short-term surgical efficacy indicators(postoperative complication rate,30 d mortality rate,length of hospital stay,etc.),long-term surgical efficacy indicators(overall survival),and quality of life were compared between the TP group and the PF high-risk PD group or the recurrence high-risk PD group.Results A total of 32 patients in the TP group and 114 patients in the PD group(99 patients in the PF high-risk PD group and 15 patients in the recurrence high-risk PD group)meeting the inclusion and exclusion criteria were enrolled.(1)TP group and PF high-risk PD group:after propensity score matching,29 patients in the TP group and 56 patients in the PF high-risk PD group were finally included.There was no PF in the TP group,and the rate of PF in the PF high-risk PD group was 19.64%(P=0.027).There were no statistical differences in short-term surgical efficacy indicators such as other postoperative complication rates,Clavien-Dindo grading,length of stay,ICU stay,and 30 d mortality between the two groups(all P>0.05).At the median follow-up time of 36 months,there was no significant difference in the quality of life questionnaire-core 30(QLQ-C30)scores between the two groups(P>0.05).(2)TP group and recurrent high-risk PD group:Since there were no statistically significant differences between the baseline data of the two groups(P>0.05),32 patients in the TP group and 15 patients in the rec

关 键 词：胰腺癌 全胰切除术 胰十二指肠切除术 倾向性评分 术后并发症 生活质量 

分 类 号：R61[医药卫生—外科学] R735.9[医药卫生—临床医学]