胰头癌扩大切除在胰头癌根治术中的作用

目的 探讨后腹膜软组织和淋巴结扩大清扫在胰头癌根治术中的作用.同时合并肠系膜上-门静脉切除的安全性和对生存率的影响.方法 2001年6月至2004年12月共施行56例胰头癌扩大切除术,根据术后病理检查有无淋巴结转移分为两组,A组:存在淋巴结转移,B组:未发现淋巴结转移;根据有无合并门静脉-肠系膜上静脉切除分为两组,Ⅰ组:未合并门静脉切除,Ⅱ组:合并门静脉切除.比较各组术后生存率.结果 56例胰头癌扩大切除术并发症发生率为30%,死亡率2%,术后1年,3年、5年生存率分别为63%,29%和16%.术后病理检查发现淋巴结阳性(A组)40例(71%),其中腹主动脉旁淋巴结阳性(A1组)11例;淋巴结阴性(B组)16例(29%),A、B两组术后生存率无明显差别,但腹主动脉旁淋巴结阳性组生存率较A、B组降低.合并门静脉切除17例,Ⅰ、Ⅱ组术后生存率无明显差别.切缘阳性5例,中位生存时间9个月,切缘阴性51例,中位生存时间23个月.结论 胰头癌扩大切除以及合并门静脉切除可以安全施行,对部分淋巴结阳性的胰头癌有一定意义,但未能提高腹主动脉旁淋巴结阳性病人的长期生存率,门静脉侵犯并非预后不良的组织学指标.

Importance of extended radical resection for treatment of pancreatic head cancer

Objective To investigate the importance of extended lymphadenectomy and retro-peritoneal soft tissue clearance for the patients with ductal adenocarcinoma of the pancreas,and mor-bidity,mortality and survival of patients with ductal adenocarcinoma of the pancreas receiving pancrea-tectomy with en bloc portal vein resection. Methods The clinical data of 56 patients with ductal ade-nocarcinoma of the pancreas undergoing extended radical resection in our hospital between 2001 and 2004 were retrospectively analyzed. In addition, they were categorized into two groups according to whether there were positive lymph nodes: group A (n=40) of positive lymph nodes and group B (n=16) of negative lymph nodes. They were also categorized into two groups according to whether there was combined superior mesenteric-portal vein(SMPV) resection: group Ⅰ (n = 39) of no combined SMPV resection and group Ⅱ (n= 17) of combined SMPV resection. Results The morbidity and mor-tality of the 56 patients were 30% and 2%, respectively. The overall 1-, 3-and 5-year survival rates were 63%, 29% and 16%, respectively. Postoperative pathological examination found 40 cases (71%)of positive lymph node. Of those 11 cases of paraaortic lymph node involvement, 16 (29%) were of negative lymph node. There were no significant difference in 1-,3-and 5-year survival rates between group A and B,while the survival curve for those with paraaortic lymph node involvement was signifi-cantly worse than group A and B. The combined SMPV resection was performed in 17 cases, no signif-icant differences in 1-,3-and 5-year survival rates between group Ⅰ and Ⅱ were found. The mean surviv-al of patients with microscopically positive margin (n = 5) was only 9 months as compared with 23months in those with microscopically negative margin (n= 51). Conclusion If selected carefully, ex-tended lymphadenectomy and retroperitoneal soft tissue clearance combined with SMPV resection canbe performed safely. Extended radical resection will be benefit to some patients with positive lymphnode, but can not increase the survival rate of patients with positive paraaortic lymph node. SMPV re-section should be performed only when a margin-negative resection is expected to be achieved. SMPV invasion are not associated with histological parameters suggesting a poor prognosis.