肝胰病灶同步切除治疗胰腺癌肝转移的安全性及对预后的影响

目的:探讨肝胰病灶同步切除治疗胰腺癌肝转移（pancreatic cancer with liver metastases，PCLM）的安全性及对预后的影响。方法:回顾性分析盛京医院2012年1月至2017年12月收治的27例行肝胰病灶同步切除的PCLM患者的临床资料，分析影响预后的相关因素。并分别通过与27例行胰腺根治手术的无肝转移胰腺癌患者及20例行姑息性旁路手术的PCLM患者比较，评估肝胰病灶同步切除的意义。结果:对27例肝胰病灶同步切除的胰腺癌肝转移患者临床特征及治疗方式进行多因素分析，可能影响预后的变量为:肝转移灶个数、γ-谷酰胺转肽酶（GGT）。接受肝胰病灶同步切除的PCLM患者的中位生存期低于单纯行胰腺切除的无肝转移胰腺癌患者［(5.3±0.5)个月vs (12.1±0.3)个月，P<0.001］，与行姑息性旁路手术的PCLM患者相比，差异无统计学意义［(5.3±0.5)个月vs (4.1±0.1)个月，P=0.932］。肝胰病灶同步切除组的手术时间、术后感染发生率多于单纯胰腺切除组，术中出血量、术后并发症总体发生率、术后住院天数，两组差异无统计学意义；肝胰病灶同步切除组的手术时间、术中出血量、术后并发症总体发生率、术后住院天数均多于姑息性旁路手术组。结论:肝胰病灶同步切除治疗PCLM可以相对安全的进行，个别患者可能从中受益，其中GGT无明显升高的孤立性PCLM患者，预后相对较好。但现阶段对预后改善有限，且并不明显优于姑息性旁路手术，不能明显提高整体生存率。

The safety and prognosis of simultaneous resection of pancreatic carcinoma with synchronous liver metastases

Objective:To investigate the safety and prognosis of simultaneous resection of pancreatic carcinoma with liver metastases(PCLM).Methods:We retrospectively analyzed 27 pancreatic cancer patients with liver metastases who underwent simultaneous resection at Shengjing Hospital，from January，2012 to December，2017 and explored factors associated with prognosis.We evaluated the significance of simultaneous resection by comparison with 27 pancreatic cancer patients without liver metastases who underwent pancreatic resection and 20 pancreatic cancer patients with synchronous liver metastases who underwent palliative bypass alone.Results:Multivariate analysis for clinical features and therapeutic methods showed that the number of liver metastases，gamma-glutamyl transpeptidase(GGT) were prognostic variables with statistical significance.The prognosis of patients who underwent simultaneous resection was worse than patients without liver metastases who underwent pancreatic resection［(5.3±0.5)months vs (12.1±0.3)months，P<0.001］，and there was no significant difference in the survival time between PCLM patients who underwent simultaneous resection and who underwent palliative bypass［(5.3±0.5)months vs (4.1±0.1)months，P=0.932］.The operative time and postoperative infection rate of simultaneous resection group were more than simple pancreatic resection group.There was no significant difference in intraoperative blood loss，complications，length of postoperative hospital stay between the two groups.The operative time，intraoperative blood loss，complications，length of postoperative hospital stay of patients who underwent simultaneous resection were more than patients who underwent palliative bypass.Conclusion:Simultaneous resection of pancreatic carcinoma with synchronous liver metastases can be performed safely.The prognosis of patients with low GGT and isolated liver metastases is relatively good.But simultaneous resection plays a limited role in improving prognosis，and not obviously better than palliative bypass，and can not significantly improve the overall survival rate.