胰头癌患者肠系膜上动脉周围淋巴结清扫与细胞角蛋白检测的意义

Significance of dissection of lymph nodes along superior mesenteric artery and cytokeratin detection of resected lymph nodes in patients with pancreatic head carcinoma

目的:探讨胰头癌患者肠系膜上动脉(SMA)周围淋巴结(第14组淋巴结)清扫与淋巴结细胞角蛋白(CK)检测的临床价值。方法:分析24例单纯行胰十二指肠切除术(PD)胰头癌患者(PD组)与32例行PD+SMA周围淋巴结清扫术胰头癌患者(PD+SMA清扫组)的临床资料,比较两组围手术期情况与术后生存率;比较常规病理学检测与CK免疫组化检测对淋巴结微转移的检出率。结果:PD组与PD+SMA组比较,术中出血量[(1 462.5±911.73)mL vs.(1 687.5±1 522.63)mL],手术时间[(4.5±1.03)h vs.(5.0±1.25)h],术后住院时间[(16.13±3.09)d vs.(18.25±7.17)d]及术后并发症发生率(8.3%vs.9.4%)的差异均无统计学意义(均P>0.05);PD+SMA清扫组术后3年生存率明显高于PD组(P=0.044);PD+SMA清扫组切除的淋巴结常规病理检测阳性率为6.25%(2/32),经CK检测增加至21.88%(7/32)。结论:胰头癌患者SMA周围淋巴结中肿瘤细胞微转移发生率较高,CK检测能提高淋巴结微转移的检出率。PD加行SMA的骨骼化清扫并不增加手术风险及术后并发症发生率,且能改善胰头癌患者预后。

Objective： To assess the clinical value of the dissection of lymph nodes along the superior mesenteric artery （SMA） （14th group） and cytokeratin （CK） staining ofresected lymph nodes in patients with pancreatic head carcinoma. Methods： The clinical data of 24 patients undergoing pancreaticoduodenectomy （PD） alone （PD group） and 32 patients undergoing PD plus dissection of lymph nodes along the SMA （PD±SMA clearance group） for pancreatic head cancer were analyzed. The perioperative conditions and postoperative survival rates between the two groups were compared, and the detection rates for lymphatic micrometastasis between routine pathological examination and CK immunohistochemical staining were also compared. Results： Comparing PD group versus PD±SMA clearance group, there were no significant differences in operative time [（4.5±1.03） h vs. （5.0±1.25） hi, intraoperative blood loss [（1 462.5±911.73） mL vs. （1 687.5± 1 522.63） mL], length of postoperative hospital stay [（16.13±3.09） d vs. （18.25±7.17） d], or incidence of postoperative complications （8.3% vs. 9.4%） （all P〉0.05）. The 3-year survival rate in PD±SMA clearance group was significantly higher than that of PD group （P=0.044）. The positive rate of lymph node metastasis was 6.25% （2/32） by routine pathological examination, which was increased to 21.88% （7/32） by detection of CK immunohistochemical staining. Conclusion： There is a relatively high incidence of lymphatic micrometastasis along the SMA in pancreatic head cancer patients, and CK determination can raise the detection rate of lymphatic micrometastasis. PD plus skeletonized dissection of the SMA does not increase the surgical risk or incidence of postoperative complications, and furthermore, it may improve the prognosis of pancreatic head cancer patients.