区域淋巴结廓清在胰十二指肠切除术中的临床意义

目的　探讨以区域淋巴结廓清为重点的胰十二指肠切除术的手术疗效。　方法　对1996年～ 2 0 0 1年间所施行的胰十二指肠切除术的 12 1例患者进行前瞻性对照研究。患者的选择根据 7项标准入选 ,其中廓清组 5 0例 ,常规手术组 71例。 2组患者在年龄、性别、术前危险因素、术中情况、术后并发症、住院时间等方面无显著差异 ,具有可比性。我们对 2组的围手术期情况、病理资料、生存率进行了对照分析。　结果　 2组患者的肿瘤大小、神经浸润等方面无差异 ,而淋巴结清除数目及淋巴结转移率廓清组显著高于常规组 ;廓清组死亡例数显著低于常规组 (P <0 0 1) ,生存率曲线显著高于常规组 (P <0 0 5 ) ,廓清组的 1、3、5年生存率分别为 70 8%、31 4 %、2 0 9% ,高于常规组。廓清组中淋巴结阳性与阴性病例的生存率无显著差异 ,同时淋巴结转移病例中肠系膜根部淋巴结阳性与阴性的生存率也无统计学差异。　结论　在胰头癌根治术中区域淋巴结廓清的应用可以有效地清除更多的淋巴结 ,减少术后局部复发的发生率 ,使远期生存率得到提高。

Clinical significance of regional lymphadenectomy in radical resection of ductal adenocarcinoma in the pancreatic head

Objective To prospectively evaluate the long-term effect of pancreaticoduodenectomy with regional lymphadenectomy. Methods One hundred and twenty-one patients with ductal adenocarcinoma in the pancreatic head treated from 1996 to 2001 were studied prospectively. The enrollment of the patients was dopendent on 7 criteria. The patients were divided into two groups: regional lymphadenectomy (group A, n =50) and routine Whipple procedure (group B, n =71). Their pre- and postoperative conditions, clinicopathological data, survival rates were studied. Results It was comparable between the 2 groups in age, sex, preoperative risk factors, operative management, and postoperative complication. Clinicopathological results showed no difference in tumor size and plexus invasion; but the frequency of lymph node involvement and the amount of resected lymph node in group A were significantly higher than those in group B. The rate of local recurrence was significantly higher in group A than in group B. The survival rates of 1-, 3-, 5-year in group A were 70.8%, 31.4%, 20.9%, respectively, which were higher than those in group B. No direct relations were observed between nodal involvement and survival rate. Conclusion Lymphadenectomy in radical pancreaticoduodenectomy could remove lymph nodes effectively and sufficiently, and reduce the rate of local recurrence so as to improve the long-term survival rate.