微创手术治疗胰腺腺泡细胞癌的效果分析

Effectiveness of minimally invasive surgery in the treatment of pancreatic acinar cell carcinoma

目的探讨微创手术治疗胰腺腺泡细胞癌(PACC)的效果。方法回顾性选择北京大学第三医院2010年1月至2022年9月确诊的6例PACC患者为研究对象。术前评估病变是否具备手术条件,包括肝脏转移病灶能否行根治性切除,对6例患者行腹腔镜或者达芬奇机器人辅助切除术,根据术中原发病灶情况以及与周围血管和组织关系决定是否保留脾脏,对于周围器官组织侵犯病例行同期切除。收集并分析患者的基本资料、术前一般情况、术前诊断和肿瘤分期、采用的微创手术方式、术后并发症、病理结果、肿瘤分期和随访等,探讨微创手术的效果。结果6例患者中男4例、女2例,年龄25~69岁。5例患者术前有腹痛和腹胀,5例患者肿瘤位于胰腺体尾部,1例患者肿瘤位于胰头部。通过术前影像学(增强CT和MRI)测量肿瘤直径2.8~10.0 cm,有2例患者术前肿瘤标记物升高,6例患者均通过腹腔镜和机器人平台完成手术,术中及术后无临床相关性术后胰瘘和出血等并发症。有2例合并同时性或异时性肝转移,2例术后病理提示出现了淋巴结转移和癌结节转移,有4例肿瘤侵犯了周围脏器(胃、脾脏或十二指肠),3例提示有脉管癌栓。6例患者随访时间12~165个月,其中1例患者由于术后肝脏转移和残余胰腺再发肿瘤经历3次手术,效果满意,截至末次随访6例患者均存活。结论PACC肿瘤容易侵犯周围脏器,肿瘤直径较大,通过微创手术可以完成PACC的根治性手术,经过微创手术能够取得满意的肿瘤学预后,并且部分复发和转移后的PACC仍可进行手术治疗。

Objective To explore the effectiveness of minimally invasive surgical treatment for pancreatic acinar cell carcinoma(PACC).Methods Six patients with PACC diagnosed in Peking University Third Hospital from January 2010 to September 2022 were retrospectively selected.Preoperative evaluation was performed on whether the lesions were eligible for surgery,including whether radical resection of liver metastases could be performed.Laparoscopic or Da Vinci robot-assisted resection was performed on six patients,and spleen retention was determined according to the original lesions and the relationship with peripheral blood vessels and tissues,while simultaneous resection was performed on cases of peripheral organ tissue invasion.The patients′basic information,preoperative general conditions,preoperative diagnosis and tumor stage,minimally invasive surgery methods,postoperative complications,pathological results,tumor stage and follow-up data were collected and analyzed to explore the effectiveness of minimally invasive surgery.Results Among the six patients,four were males and two were females,with the age of 25-69 years.Five patients had abdominal pain and distension before surgery,five patients had tumors located at the tail of the pancreatic body,and one patient had tumors located at the head of the pancreas.Preoperative imaging(enhanced CT and MRI)was performed to measure the tumor diameter(2.8-10.0 cm).Tumor markers were elevated in two patients before surgery,and six patients underwent surgery through laparoscopy or robotic platform.No complications such as postoperative pancreatic fistula and bleeding were clinically relevant during and after surgery.There were two cases with concurrent or heterochronous liver metastasis,two cases with lymph node metastasis and nodular metastasis,four cases with tumor invasion of surrounding organs(stomach,spleen or duodenum),and three cases with vascular cancer thrombi.The follow-up time of the six patients was 12 to 165 months,and one patient underwent three operations due to postoperative liver metastasis and residual pancreatic recurrence,and the results were satisfactory.All the six patients survived at the last follow-up.Conclusions PACC is prone to invade the surrounding organs,and has a large tumor diameter.Radical surgery for PACC can be completed through minimally invasive surgery,and satisfactory oncology prognosis can be obtained.In addition,some PACC patients with recurrence and metastasis can still be treated by surgery.