扩大根治性与标准根治性胰十二指肠切除术的疗效比较

目的 探讨扩大根治性胰十二指肠切除术与标准根治性胰十二指肠切除术治疗胰头癌的疗效.方法 回顾性分析2001年至2011年四川大学华西医院收治的96例胰头癌患者的临床资料,根据患者的手术方式分为扩大组(行扩大根治性胰十二指肠切除术,41例)和标准组(行标准根治性胰十二指肠切除术,55例).观察并比较两组患者术中、术后和随访情况,并根据肿瘤患者生命质量评分标准对两组患者术后1年生命质量进行量化比较.所有计量资料采用秩和检验,计数资料采用方差分析,2个或多个样本率或构成比的比较采用x2检验.Kaplan-Meier法计算生存率,生存率比较采用Log-rank检验.结果 在两组患者年龄、肿瘤分化程度、肿瘤平均直径及淋巴结转移数目等基线情况无差异的情况下,扩大组患者的平均手术时间、术中平均出血量和术后平均住院时间分别为364 min(310～650 min)、680 ml (0～1800 ml)和13.5 d(10～76 d),明显高于标准组的315 min(260 ～306 min)、305 ml(0 ～ 1000 ml)和9.2d(7～30 d),两组比较,差异有统计学意义(F=7.15,4.22,3.82,P＜0.05).扩大组患者1级、2级和3a级并发症发生率分别为5％( 2/41)、20％(8/41)和41％( 17/41),而标准组患者分别为25％( 14/55)、49％(27/55)和7％ (4/55),两组比较,差异有统计学意义(x2 =5.76,8.87,14.10,P＜0.05).两组患者3b级、4a级并发症发生率比较,差异无统计学意义(x2=1.44,0.88,P＞0.05).两组患者的术后1、3、5年生存率,中位生存时间,术后1年生命质量评分及术后平均肿瘤复发时间比较,差异无统计学意义(x2 =0,0.13,0,F=0.49,1.03,t =0.32,P＞0.05).结论 标准根治性胰十二指肠切除术能够为普通胰头癌患者带来最佳的风险效率比,只有对于那些术前或术中发现有第16组淋巴结肿大且肿瘤能够达到R0切除的患者,才谨慎选择扩大根治性胰十二指肠切除术.

Efficacies of extended and standard radical pancreatoduodenectomy

Objective To compare the efficacies of extended and standard radical pancreatoduodenectomy (RPD) for the treatment of pancreatic cancer in head of pancreas.Methods The clinical data of 96 patients with pancreatic cancer in head of pancreas who were admitted to the West China Hospital of Sichuan University from 2001 to 2011 were retrospectively analyzed.Forty-one patients who received extended RPD were in the extended group and 55 patients who received standard RPD were in the standard group.Blood loss,operation time,hospital stay,surgical complications,severity of complication,1-,3-,5-year survival rate,median survival time,time and location of tumor recurrence and 1-year quality of life of the patients in the 2 groups were compared.All data were analyzed by using rank sum test and analysis of variance.The survival rate was calculated by Kaplan-Meier method and was analyzed by Log-rank test.Results There were no significant differences in the age,diameter and differentiation of the tumor,and number of metastatic lymph nodes between the 2 groups.The operation time,operative blood loss,postoperative hospital stay were 364 minutes (310-650 minutes),680 ml (0-1800 ml) and 13.5 days (10-76 days) in the extended group,which were significantly higher than 315 minutes (260-306 minutes),305 ml (0-1000 ml) and 9.2 days (7-30 days) in the standard group (F=7.15,4.22,3.82,P＜0.05).The incidences of complications in grade 1 and 2 were 5％ (2/41) and 20％ (8/41) in the extended group,which were significantly lower than 25％ ( 14/55 ) and 49％ (27/55) in the standard group ( x2 =5.76,8.87,P ＜ 0.05).The incidence of complications in grade 3a was 41％ ( 17/41 ) in the extended group,which was significantly higher than 7％ (4/55) in the standard group ( x2 =14.10,P ＜ 0.05 ).There were no significant differences in the incidence of complications in grade 3b and 4a between the 2 groups ( x2 =1.44,0.88,P ＞ 0.05 ).There were no significant difference in the 1-,3-,5-year survival rate,median survival time,postoperative quality of life and time of tumor recurrence between the 2 groups ( x2 =0,0.13,0; F =0.49,1.03,t =0.32,P ＞ 0.05 ).Conclusion Standard RPD is optimal for patients with ordinary pancreatic cancer in head of pancreas.Extended RPD could be applied for patients with enlargement of group 16 lymph nodes and could receive R0 resection.