全胰切除术对胰腺肿瘤的近远期疗效分析

目的 探讨全胰切除术（TP）在胰腺肿瘤患者中的近远期疗效。方法 回顾性纳入2005年6月至2018年3月复旦大学附属中山医院43例TP患者,分析其临床病理特征、手术情况、术后并发症及总生存期。结果 本组共43例,其中胰腺导管腺癌（PDAC）25例,胰腺导管内乳头状黏液瘤（IPMN）14例,实性假乳头状瘤2例,腺鳞癌1例,神经内分泌肿瘤（NET）1例。并发症发生率为76.7%,30 d病死率为7.0%,中位生存期为20.0个月。与PDAC组比较,IPMN组患者输血率（21.4% vs 60.0%,P=0.043）、联合血管切除率（21.4% vs 64.0%,P=0.019）和腹腔感染率（0 vs 32.0%,P=0.034）均较低,且术后住院时间较短（11.5 d vs 23.0 d,P=0.004）。进一步分析表明,浸润性IPMN患者在TP术后获得了更长的远期生存（35.8个月 vs 15.0个月,P=0.033）。结论 TP术式安全可行且在部分病例中能获得良好的肿瘤学效果,IPMN可能是较PDAC更优选的手术适应证。

Short- and long-term therapeutic effects of total pancreatectomy in pancreatic tumors

Objective To analyze the short- and long-term therapeutic effects of total pancreatectomy (TP) in pancreatic tumor patients. Methods Forty-three patients underwent TP in Zhongshan Hospital, Fudan University from Jun. 2005 to Mar. 2018 were retrospectively included. Investigations on clinicopathological characteristics, operative details, postoperative outcomes and long-term survival of TP patients were performed. Results The pathological types included pancreatic ductal adenocarcinoma (PDAC, n=25), intraductal papillary mucinous neoplasm (IPMN, n=14), solid pseudopapillary tumor (n=2), adenosquamous carcinoma (n=1) and neuroendocrine tumor (n=1). The complication rate after TP was 76.7% with a 30-day mortality rate of 7.0%, and the median overall survival of the cohort was 20.0 months. Comparative analysis between the PDAC and IPMN groups showed the IPMN patients were associated with lower transfusion (21.4% vs 60.0%, P=0.043), vascular resection (21.4% vs 64.0%, P=0.019) and intra-abdominal infection rates (0 vs 32.0%, P=0.034) and shorter postoperative hospital stays (11.5 d vs 23.0 d, P=0.004). Further analysis indicated the invasive IPMN patients acquired better long-term survival after TP (35.8 months vs 15.0 months, P=0.033). Conclusion TP is feasible and could achieve good oncological outcomes when applied to selected patients, and IPMN could be superior to PDAC as an indication for this procedure.