摘要
目的探讨8a组淋巴结阳性能否作为胰头癌胰十二指肠切除术(PD)扩大淋巴结清扫的依据。方法回顾分析2014年1月至2019年6月湖南省人民医院肝胆医院胰脾外科收治的165例胰头癌行PD并行淋巴结清扫患者的临床资料,其中男性101例,女性64例,年龄范围38~75岁,中位年龄57岁。165例患者中行标准淋巴结清扫纳入标准组(n=88),扩大淋巴结清扫纳入扩大组(n=77)。165例患者分为A组(n=61):8a组淋巴结阴性行标准淋巴结清扫;B组(n=47):8a组淋巴结阴性行扩大淋巴结清扫;C组(n=27):8a组淋巴结阳性行标准淋巴结清扫;D组(n=30):8a组淋巴结阳性行扩大淋巴结清扫。比较手术时间、术中出血量和术后生存率、并发症等。结果标准组患者手术时间、术中出血量分别为(456.8±30.4)min、(264.28±101.14)ml,低于扩大组(507.1±45.7)min、(388.9±155.3)ml,差异有统计学意义(均P<0.05)。术后并发症发生率扩大组为31.2%(24/77),高于标准组的14.8%(13/88),差异具有统计学意义(P<0.05)。术后累积生存率A组与B组比较,B组与D组比较,差异均无统计学意义(均P>0.05)。术后累积生存率C组低于D组,A组高于C组,差异均有统计学意义(均P<0.05)。结论扩大淋巴结清扫的PD可提高8a组淋巴结阳性胰头癌患者的生存率,对于此类患者应行扩大淋巴结清扫。若为阴性,建议行标准淋巴结清扫。
Objective To study the value of metastatic positivety in lymph nodes group 8a in deciding on extended lymph node dissection in pancreaticoduodenectomy(PD)for pancreatic head cancer.Methods A retrospective study on 165 patients with pancreatic head cancer treated with PD at the Department of Pancreas and Spleen Surgery,Hepatobiliary Hospital of Hunan Provincial People's Hospital between January 2014 to June 2019 was performed.There were 101 males and 64 females with ages ranging from 38 to 75(median 57)years.Patients who underwent standard lymph node dissection were included in the standard group(n=88),and extended lymph node dissection in the extended group(n=77).These patients were further divided into 4 subgroup.Subgroup A(standard PD in patients with negative nodes in group 8a,n=61),Subgroup B(extended PD in patients with negative nodes in group 8a,n=47),Subgroup C(standard PD in patients with positive nodes in group 8a,n=27),and Subgroup D(extended PD in patients with positive nodes in group 8a,n=30).The operation time,intraoperative blood loss,postoperative survival rates,complications were compared among the groups and subgroups.Results The operation time and intraoperative blood loss of the standard group were(456.8±30.4)min and(264.28±101.14)ml,respectively,which were significantly lower than the extended group of(507.1±45.7)min and(388.9±155.3)ml(all P<0.05).The incidence of postoperative complications in the extended group(31.2%,24/77)was significantly higher than that in the standard group(14.8%,13/88)(P<0.05).When compared with subgroup B,the cumulative survival rate of patients in subgroup A was not significantly different(P>0.05).However,the cumulative survival rate of patients in subgroup C was significantly lower than that in subgroup D(P<0.05).The cumulative survival rate of subgroup A was also significantly better than that of subgroup C(P<0.05).There was no significant difference in the cumulative survival rates between group B and group D(P>0.05).Conclusions PD with extended lymph node dis
作者
陈梅福
唐泽涛
姚佳水
成伟
朱朝庚
李国光
蔡翊
谢阳云
Chen Meifu;Tang Zetao;Yao Jiashui;Cheng Wei;Zhu Chaogeng;Li Guoguang;Cai Yi;Xie Yangyun(Department of Pancreatic and Splenic Surgery,Hepatobiliary Hospital of Hunan Provincial People's Hospital,the First Affiliated Hospital of Hunan Normal University,Translational Medicine Laboratory of Pancreas Disease of Hunan Normal University,Changsha 410005,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2021年第4期287-290,共4页
Chinese Journal of Hepatobiliary Surgery
基金
湖南省人民医院仁术基金项目(RS201607)。
