胰头癌外科根治相关问题的探讨

Factors influencing survival after resection for pancreatic adenocarcinoma

目的探讨胰腺癌外科根治切除术中淋巴清扫D2合并神经鞘、神经束切除的价值。方法对天津医科大学肿瘤医院5年间58例胰头癌行根治切除R0，D2手术同时行神经鞘、神经束切除的病例与同期76例未行神经鞘、神经束切除的R0，D2手术进行对照观察。结果58例行神经鞘切除的病人中有36例（62．1％）经病理证实有神经浸润，22例（37．9％）无浸润。其1、3年生存率分别为61．1％，36．1％和86．4％，59．1％。而神经鞘切除组58例与76例未行神经鞘切除组相比，1、3年生存率分别为70．7％，44．8％和60．5％，25．0％。结论胰腺癌易早期转移。除淋巴结、血行转移和种植转移外，神经浸润转移沿神经鞘、嗜神经转移是其独特的生物学行为，在根治术中应注重这一特征，行神经鞘、神经束切除对提高生存率有一定的临床价值。

Objective To determine the value of resection of D2 and nerve plexus dissection for treatment of pancreatic adenocarcinoma. Methods The clinical data of 58 patients with pancreatic head carcinoma receiving combined resection of D2 and nerve plexus were compared with those of 76 receiving only resection of D2 from January 1997 to January 2002. Results Of the 58 patients receiving the combined resection, 36 （ 62. 1% ） had pathologically proven nerve invasion and 22 （ 37. 9 %） had not. Their 1- and 3-year survival rates were 61.1%, 86.4% and 36.1%, 59.1%, respectively. Meanwhile, the 1- and 3-year survival rates of the 58 patients receiving the combined resection and 76 receiving only the resection of D2 were 70.7% vs. 60. 5% and 44. 8% vs. 25.0%, respectively. Conclusion The early metastasis is easy to occur for pancreatic carcinoma. Besides metastasis through lymph nodes, blood and implantation, it has the unique biological behavior of metastasis through nervous system, which should be paid close attention to during the tumor resection. Nerve plexus dissection is of certain clinical value for promoting survival rate of the patients.