胰头癌切除并腹膜后淋巴清扫的价值及意义初探

目的探讨胰头癌切除联合腹膜后淋巴清扫的价值及意义。方法排除随访不全及术后接受辅助治疗的病人后，收入1994-1997年以标准胰十二指肠切除（仅清扫胰周淋巴结，整块切除标本）治疗的胰头癌病人20例，1998-2001以标准手术联合腹膜后淋巴清扫治疗的病人28例，回顾性研究两组病人的临床病理资料，比较术后合并症及术后生存期等临床指标的差异。结果两组临床病理资料具有可比性，扩大根治组标本内淋巴结数量大于标准手术组（P〈0．05），腹膜后淋巴结阳性率为21．43％（6／28）。两组术中输血量、术后合并症及总的术后生存期无显著性差异，两组各有1例围手术期死亡病人。比较淋巴结阳性病人的术后生存期，扩大根治组长于标准手术组（P＜0．05）。扩大根治组可见腹泻、淋巴漏等术后合并症。结论胰头癌切除联合腹膜后淋巴清扫未增加术后合并症，可改善淋巴结阳性病人的术后生存期。

Extended retroperitoneal lymphadenectomy for surgical treatment of adenocarcinoma of the head of pancreas

Objective To determine the value of extended retroperitoneal lymphadenectomy for surgical treatment of adenocarcinoma of the head of pancreas.Methods Twenty patients with adenocarcinoma of the head of pancreas were treated with standard pancreatoduodenectomy during 1994-1997(group A) and 28 patients with the same disease underwent extended retroperitoneal lymphadenectomy associated with standard pancreatoduodenectmy between 1998-2001(group B).The patients without enough follow-up data or receiving postoperative adjuvant therapy were excluded from the analysis.Clinical and pathological parameters in both groups were reviewed.The postoperative morbidity,mortality and survival rate were compared between the 2 groups.Results Demographic and histopathological features were similar in the 2 groups.The performance of the extended lymphadenectomy added time to the procedure.The mean total number of lymph nodes resected was significantly higher in group B than in group A(P<0.05).Of the 28 cases in group B,6(21.43%) had metastatic adenocarcinoma in the resected retroperitoneal lymph nodes.The transfusion requirements,postoperative morbidity and overall survival rate were not significantly different between the 2 groups.There was one perioperative death in each of the 2 groups.When subgroups of patients were analyzed,there was a significantly higher survival rate in node-positive patients after the extended rather than standard lymphadenectomy(P<0.05).The complications of postoperative diarrhea and lymphocele were only observed in group A.Conclusions The addition of an extended lymphadenectomy to a pancreatoduodenectomy does not significantly increase morbidity.However,the survival rate of the node-positive patients might be increased by the procedure.