胰腺全系膜切除在胰头癌根治术中的应用价值  

Application value of total mesopancreas excision in radical resection of pancreatic head cancer

作　　者：罗柳平 吴萌萌 陈欣磊 林科灿[2] Luo Liuping;Wu Mengmeng;Chen Xinlei;Lin Kecan(Department of Hepatobiliary and Pancreatic Surgery,Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou 350046,China;Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350006,China)

机构地区：[1]福建医科大学孟超肝胆医院肝胆胰外科,福州350046 [2]福建医科大学附属第一医院肝胆胰外科,福州350006

出　　处：《中华肝脏外科手术学电子杂志》2024年第5期651-656,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：福州市临床重点专科建设项目(20230101)

摘　　要：目的探讨胰腺全系膜切除(TMpE)在胰头癌根治术中的应用价值。方法回顾性分析2018年1月至2022年12月在福建医科大学孟超肝胆医院行胰十二指肠切除术(PD)的78例胰头癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。根据手术方式将患者分为PD-TMpE组和标准PD组。其中PD-TMpE组37例,男33例,女4例;年龄31~74岁,中位年龄58岁;标准PD组41例,男31例,女10例;年龄28~80岁,中位年龄59岁。比较两组围手术期指标,包括手术时间、术后R0切除率、淋巴结清扫个数、淋巴结阳性个数、术后并发症发生率、术后复发时间及复发类型等。两组手术时间等比较采用t检验,率的比较采用χ^(2)检验。生存分析采用Kaplan-Meier法和Log-rank检验。结果PD-TMpE组与标准PD组平均手术时间分别为(367±70)、(392±76)min,差异无统计学意义(t=-1.540,P>0.05)。PD-TMpE组R0切除率为92%(34/37),明显高于标准PD组的73%(30/41)(χ^(2)=4.330,P<0.05)。PD-TMpE组术后1年肿瘤复发率为16%(6/37),明显低于标准PD组的39%(16/41)(χ^(2)=4.996,P<0.05)。PD-TMpE组中位无复发生存期为17.9个月(95%CI:15.05~20.73),明显长于标准PD组的13.1个月(95%CI:13.30~17.47)(χ^(2)=3.911,P<0.05)。结论胰头癌术中采用TMpE能提高R0切除率,降低肿瘤早期复发率,且并不增加手术风险,是一种安全、有效、可行的手术方法。Objective To evaluate the application value of total mesopancreas excision(TMpE)in radical resection of pancreatic head cancer.Methods Clinical data of 78 patients with pancreatic head cancer who underwent pancreaticoduodenectomy(PD)in Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2018 to December 2022 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.All patients were divided into the PD-TMpE group and standard PD group according to surgical methods.37 patients were assigned into the PD-TMpE group,33 male and 4 female,aged from 31 to 74 years,with a median age of 58 years.41 cases were divided into the standard PD group,31 male and 10 female,aged from 28 to 80 years,with a median age of 59 years.Perioperative indexes including operation time,R0 resection rate,number of dissected lymph nodes,number of positive lymph nodes,incidence of postoperative complications,recurrence time and recurrence type were statistically compared between two groups.Operation time between two groups was compared by t test.The rates between two groups was compared by Chi-square test.Survival analysis was performed by Kaplan-Meier method and Log-rank test.Results The average operation time in the PD-TMpE and standard PD groups was respectively(367±70)and(392±76)min,and the difference was not statistically significant(t=-1.540,P>0.05).The R0 resection rate in the PD-TMpE group was 92%(34/37),significantly higher than 73%(30/41)in the standard PD group(χ^(2)=4.330,P<0.05).In the PD-TMpE group,the 1-year tumor recurrence rate was 16%(6/37),significantly lower than 39%(16/41)in the standard PD group(χ^(2)=4.996,P<0.05).In the PD-TMpE group,the median recurrence-free survival was 17.9 months(95%CI:15.05-20.73),significantly longer than 13.1 months(95%CI:13.30-17.47)in the standard PD group(χ^(2)=3.911,P<0.05).Conclusions TMpE is a safe,efficacious and feasible surgical approach for pancreatic head cancer,which can improve the

关 键 词：胰十二指肠切除术 胰腺全系膜切除 胰腺肿瘤 手术后并发症 

分 类 号：R735.9[医药卫生—肿瘤]