胰头癌根治术中腹膜后神经、淋巴、软组织廓清的临床意义

Clinical significance of radical pancreaticoduodenectomy combined with retroperitoneai nerve, lymph node and soft-tissue dissection in patients with carcinoma of the pancreatic head

目的探讨胰头癌根治术中腹膜后神经、淋巴、软纰织廓清的临床意义。方法2000年1月—2004年1月,本院对20例胰头癌患者施行腹膜后神经、淋巴结廓清根治术,并对其临床和病理资料、随访结果进行回顾性分析。结果15例（75%）患者存在淋巴结转移,平均每例检出淋巴结32.7枚（20～62枚）。按淋巴结转移率高低顺序为No.13（45%）,No.14（35%）,No.17 （25%）,No.8（20%）,No.12（15%）,No.16（15%）,No.6（10%）。9例（45%）患者有腹膜后胰外神经浸润。全组术后1例死于肾功能衰竭,1例患者于术后6月死于脑血管意外;另13例患者在术后46月内死于肿瘤局部复发及全身转移,存活超过36个月者9例,5例至今存活,全组患者3年生存率为45%。结论淋巴结转移和神经侵犯是影响胰腺癌预后的重要因素,可切除胰头癌在术中施行腹膜后神经、淋巴、软组织廓清足安全、有效的。

Objective To investigate the clinical significance of radical pancreaticoduodenectomy combined with retroperitoneal nerve, lymph node and soft-tissue dissection. Methods Clinical data of 20 patients with ductal adenocarcinoma of the pancreatic head undergoing this radical surgery from 2000 to 2003 were retrospectively analyzed. Results The regional lymph node metastasis occurred in 15 cases（75% ）, the mean number of examined lymph node was 32. 7, the most common metastatic lymph nodes were in order of No. 13（45% ）, No. 14（35% ）, No. 17（25% ） ,No. 8（20% ）, No. 12（ 15% ）, No. 16（ 15% ） and No. 6 （ 10% ）. Perineural invasion occurred in 9 cases（45% ）. One case died of renal failure after operation,one case died of cerebrovascular disease after six months, 13 cases died of tumor recurrence or metastasis in 46 months after surgery. The 3-year survival rate was 45%, Conclusion Lymph node metastasis and perineural invasion are important prognostic factor for cephalic pancreatic carcinoma. The radical pancreaticoduodenectomy combined with nerve, lymph node and soft tissue dissection in the retroperitoneum is a safe and effective procedure in the treatment of adenocarcinom in the pancreatic head.