扩大淋巴结清扫对胰头癌患者预后效果的观察

目的 探讨扩大淋巴结清扫对胰头癌患者疗效及预后的影响.方法 回顾性分析136例胰头癌患者的临床资料,根据治疗方法的不同将患者分为扩大组和常规组,每组各68例.常规组患者接受胰十二指肠切除术及常规淋巴结清扫,扩大组患者接受胰十二指肠切除术及扩大淋巴结清扫.比较两组患者的术中、术后指标及并发症发生率.结果 扩大组患者的手术时间长于常规组,术中出血量多于常规组(P﹤0.05).扩大组患者术后胃排空延迟的发生率高于常规组,阳性淋巴结检出数多于常规组,原位癌复发率低于常规组,差异均有统计学意义(P﹤0.05).术后两组患者吻合口瘘、腹腔出血及腹腔感染的发生率比较,差异均无统计学意义(P﹥0.05).随访5~33个月,两组患者的中位生存时间比较,差异无统计学意义(P﹥0.05).结论 对于行胰十二指肠切除术的胰头癌患者,扩大淋巴结清扫范围可提高阳性淋巴结检出率,降低原位癌复发率,但对患者的远期疗效无明显影响,同时加重了对患者机体的损伤,延长了手术时间,增加了术中出血量及胃排空延迟的发生率,不建议常规对患者采用扩大淋巴结清扫术,尤其是年老及身体状况较差者.

Influence of extended lymph node dissection on the prognosis of patients with pancreas head carcinoma

Objective To explore the influence of extended lymph node dissection on the efficacy and prognosis of patients with pancreas head carcinoma. Method Clinical data of 136 patients with pancreas head carcinoma were retro-spectively analyzed, and the patients were divided into extended group and conventional group according to treatment mode, with 68 cases in each group. Patients in conventional group were given pancreatoduodenectomy and conventional lymph node dissection;and the patients in the expanded group were given pancreatoduodenectomy and extended lymph node dissection. Intraoperative/postoperative indices and incidences of complications were compared between two groups. Result Compared with the conventional group, the operation duration and intraoperative blood loss significantly increased in the extended group (P<0.05). The incidence of postoperative delayed gastric emptying and the number of positive lymph nodes detected were higher and the recurrence rate of carcinoma in situ was lower in extended group than in conventional group, and the differences between two groups reached statistically significant (P<0.05). The differences in postoperative anastomotic fistula, intra-abdominal hemorrhage and intra-abdominal infection between two groups were not statistically significant (P>0.05). The difference in median survival time between two groups during a follow-up peri-od of 5 to 33 months was not statistically significant (P>0.05). Conclusion In pancreas head carcinoma patients who are undergoing pancreatoduodenectomy, extended lymph node dissection can improve the detection rate of positive lymph nodes and reduce the recurrence rate of carcinoma in situ. However, extended lymph node dissection shows no obvious ef-fect on long-term efficacy, and it can also aggravate body injuries, prolong operation time, and increase transoperative bleeding and the incidence of delayed stomach emptying. Its routine use is thus not recommended, especially for elderly patients and patients in poor clinical condition.