腹膜后神经、淋巴结及软组织廓清在胰头癌胰十二指肠切除术中的意义

Clinical significance of nerve, lymph node and soft tissue dissection in retroperitoneum in radical resection of ductal adenocarcinoma in pancreatic head

目的探讨以腹膜后神经、淋巴结及软组织廓清为重点的胰头癌胰十二指肠根治性切除术的临床意义。方法将浙江省人民医院1995年2月至2000年2月施行胰十二指肠切除术的21例胰头癌患者（常规组）和2000年2月至2005年2月施行以腹膜后神经、淋巴结及软组织廓清为重点的胰十二指肠根治性切除术的25例胰头癌患者（后腹膜廓清组）进行比较研究。两组患者在年龄、性别、术前危险因素方面差异无统计学意义，对两组的围手术期情况、病理资料、生存率进行对照分析。结果两组患者的肿瘤大小方面差异无统计学意义，术中情况、术后并发症、住院时间差异亦无统计学意义，而后腹膜廓清组的淋巴结清扫数目及转移率和神经浸润转移率显著高于常规组（P〈0．05），后腹膜廓清组的1、3年生存率分别为80％、52％，高于常规组。后腹膜廓清组中神经浸润阳性与阴性的生存率差异有统计学意义。结论在胰头癌根治术中后腹膜神经、淋巴结及软组织廓清的应用，可以有效地清除癌组织浸润的神经、淋巴组织，减少术后局部复发的发生率，使远期生存率得到提高。

Objective To investigate the clinical significance of radical pancreatoduodenectomy plus retroperitoneal nerve, lymph node and soft tissue dissection in carcinoma of pancreatic head. Methods Forty-six patients with carcinoma of pancreatic head were treated at our hospital from 1995 to 2005. They were divided into two groups： radical pancreatoduodenectomy plus retroperitoneal nerve, lymph node and soft tissue dissection （Group A, n =25） and routine Whipple＇s operation （Group B, n =21 ）. Two groups had no significant difference in age, gender and pre-operative risk factors. And the peri-operative conditions, pathological data and survival rates were compared and analyzed. Results There was no difference in tumor size, intra-operative findings, post-operative complications and length of hospitalization. But the number and positive rate of resected lymph node in Group A were significantly higher than those in Group B （ P 〈 0. 05 ）. The survival rates of 1, 3-year in Group A were 80% and 52. 9% respectively. And they were higher than those in Group B （P 〈 0.05 ）. There was significant difference in the survival rates between patients with nerve infiltration and those without in Group A （P 〈 0. 05 ） . Conclusion The radical pancreatoduodenectomy plus retroperitoneal nerve, lymph node and soft tissue dissection can effectively remove the lymph node and nerve tissues with tumor infiltration and reduce the local recurrent rate so as to improve the long-term survival rate.