区域淋巴结廓清在胰头癌根治术中的应用

目的 探讨区域淋巴结廓清结合胰十二指肠切除术治疗胰头癌的有效性和安全性。方法 在常规胰十二指肠切除术(Whipple)基础上，进行区域淋巴结廓清，同时清除从腹腔动脉干至肠系膜下动脉的后腹膜组织，重点清除肠系膜根部淋巴结(14组)、肝十二指肠韧带内淋巴结(12组)、腹主动脉旁淋巴结(16组)、以及肝动脉旁(8组)、腹腔动脉旁(9组)淋巴结。结果 53例胰头癌病人施行了以区域淋巴结廓清为重点的胰头癌根治术，其中有3例合并切除了受浸润的一段肠系膜上静脉。手术无严重并发症发生，病人均痊愈出院。53例病人中有38例(72％)发生淋巴结转移，其中以胰头后(13组)、肠系膜根部(14组)发生率最高；14组淋巴结中各亚组转移率较为平均；发生第二站淋巴结转移的比例高达63％；肿瘤大小与淋巴结转移不成正比，小于2cm的肿瘤已经有第二站淋巴结的转移；术后1，2，3，5年生存率分别为70％，52．8％，26．7％，17．8％。结论 胰头癌的淋巴结转移呈现发生早、播散远和以肠系膜根部等部位为重点的特征，以区域淋巴结廓清为重点的胰头癌根治术能较为彻底地清除区域内淋巴结以及后腹膜组织，有助于保证手术的彻底性。

Use of regional lymphadenectomy in radical resection of ductal adenocarcinoma in head of pancreas

Objective To prospectively study the safety and effect of regional lymphadenectomy in pancreaticoduodenectomy in the treatment of cancer in the head of the pancreas. Methods On the basis of routine pancreaticoduodenectoy (Whipple procedure), we performed the regional lymphadenectomy consisting of radical retroperitoneal dissection from the celiac trunk to the inferior mesenteric artery, transection of the pancreatic body away from the tumor for 3 cm and thorough resection of the uncinate process. The emphasis of the procedure was the resection of wide nodes, particularly the mesenteric root lymph nodes in 14 patients, the paraaortic lymph nodes in 16 and the lymph nodes along the hepatoduodenal ligament in 12. Results Fifty three patients underwent this procedure and there was no severe complication in all the patients. Clinicopathological observation showed that the rate of metastasis to lymph nodes was 72% (38/53). There was no relationship between tumor size and nodal involvement. The follow up study showed that the 1 , 2 , 3 and 5 year survival rates were 70 0%, 52 8%, 26 7% and 17 8%, respectively. Conclusions The lymph node involvement of cancer in pancreatic head is characterized by happening early and distant metastasis. The mesenteric root is the important site for lymph node involvement. The radical pancreaticoduodenectomy in combination with lymphadenectomy is very useful for thorough revmoval of the involved nodes and retrosperitoneal tissue. Consequently, it is beneficial to improve the survival rate of patients.