联合腹腔干切除的胰体尾切除术40例疗效分析

Distal pancreatectomy with celiac axis resection(DP-CAR) for pancreatic cancer: An analysis of 40 cases

目的评估联合腹腔干切除的胰体尾切除术(DP-CAR)安全性及治疗效果。方法回顾性分析2012年1月至2016年12月海军军医大学附属长海医院收治的40例行DP-CAR的胰腺癌病人的临床病理学资料,分析术后并发症发生率、病死率及中位生存期。结果40例病人在院并发症发生率(Clavien-Dindo评分≥2级)为13例(32.5%),其中因肝缺血导致肝衰竭术后90 d内死亡1例(2.5%),B级以上胰瘘6例(15.0%),胃排空障碍7例(17.5%),严重腹腔感染6例(15.0%),乳糜漏4例(10.0%),术后出血4例(10.0%);总中位生存时间19.1个月(IQR8.9,30.8个月),1、3、5年存活率分别为62.5%、17.5%、5.0%,T4期较T1-3期病人的中位生存期(14.2个月vs.24.1个月,P=0.0225)、有淋巴结转移N1-2期较N0期病人的中位生存期(8.8个月vs.23.2个月,P=0.00967)更差。结论在高选择的胰体尾病人中,DP-CAR的术后并发症发生率和病死率、中位生存期是可接受的,对T4期和术前影像学评估有区域淋巴结肿大的病人建议行新辅助治疗后再评估手术的可行性。

Objective To assess the safety and efficacy of distal pancreatectomy with celiac axis resection(DP-CAR).Methods The clinical and pathological data of 40 patients with pancreatic cancer who underwent DP-CAR at the Changhai Hospital affiliated to the Naval Military Medical University from January 2012 to December 2016 were analyzed retrospectively.The postoperative incidence of complications,mortality and overall survival were analyzed respectively.Results The incidence of complication in the 40 patients(Clavien-Dindo score≥2)was 32.5%(13 cases)including 1 case(2.5%)died of liver failure in 90 days after surgery due to hepatic ischemia,6 cases(15.0%)of grade B or above pancreatic fistula,7 cases(17.5%)of gastric emptying disorder,6 cases(15,0%)of severe abdominal infection,4 cases(10.0%)of chyle leakage,and 4 cases(10%)of postpancreatectomy hemorrhage(PPH).Total median survival was19.1 months(IQR 8.9,30.8 months),one-year,three-year and five-year survival rate:62.5%,17.5%and 5.0%.Patients of T4(median survival:T414.2 months vs.T1-324.1 months,P=0.0225),lymph node metastasis of N1-2(median survival:N1-28.8 months vs.NO 23.2 months,P=0.00967)had a worse median survival time.Conclusion In high-selective patients with pancreatic body/tail cancer,the morbidity,mortality and median survival after DP-CAR surgery are acceptable,and patients with T4 and regional lymph nodes enlargement in preoperative imaging evaluation should be performed neoadjuvant therapy,and then be re-evaluated before DP-CAR.