胰腺全系膜切除的胰十二指肠切除术治疗壶腹周围癌及胰头癌的安全性及疗效分析

Safety and efficacy of total mesopancreas excision with pancreaticoduodenectomy in treatment of periampullary carcinoma and pancreatic head carcinoma

目的比较胰腺全系膜切除(TMpE)的胰十二指肠切除术与标准胰十二指肠切除术(Whipple术)的手术安全性及术后疗效。方法对西南医科大学附属医院肝胆外科2013年8月至2017年12月期间施行的123例胰十二指肠切除术患者进行回顾性分析,其中胰头癌47例,壶腹周围癌76例,胰头癌和壶腹周围癌患者按所行手术方式分为TMpE组和Whipple组,分别对同一部位行不同手术方式患者的手术时间、术中出血量、术后住院时间、术后胃肠道功能恢复时间、术后并发症、术后生存情况等进行比较分析。结果 (1)胰头癌和壶腹周围癌患者的TMpE组和Whipple组间基线资料比较差异均无统计学意义(P>0.05)。(2)胰头癌患者TMpE组和Whipple组的手术时间、术后住院时间及术后胃肠道功能恢复时间比较差异均无统计学意义(P>0.05),但TMpE组的术中出血量明显多于Whipple组(P=0.038);壶腹周围癌患者TMpE组和Whipple组的手术时间、术后住院时间、术后胃肠道功能恢复时间及术中出血量比较差异均无统计学意义(P>0.05)。(3)胰头癌患者的总并发症发生率TMpE组明显高于Whipple组(χ~2=6.595,P=0.010),而壶腹周围癌患者的总并发症发生率在TMpE组和Whipple组间比较差异无统计学意义(P>0.05)。(4)胰头癌患者的累积生存曲线TMpE组优于Whipple组(χ~2=9.597,P=0.002),壶腹周围癌患者TMpE组和Whipple组的累积生存曲线在TMpE组和Whipple组间比较差异无统计学意义(χ~2=0.844,P=0.358)。结论对于胰头癌患者行TMpE的胰十二指肠切除术相较于标准Whipple术而言,虽然增加了术中出血量及近期手术总体并发症发生率,但术后恢复时间及手术安全性与Whipple术无明显差异且患者术后生存时间得到明显延长;对壶腹周围癌患者而言,行TMpE的胰十二指肠切除术较之Whipple术在手术安全性、患者术后远期生存率及生存时间上无明显差异。

Objective To compare surgical safety and postoperative efficacy of total mesopancreas excision (TMpE)with pancreaticoduodenectomy (PD)and standard PD (Whipple).Methods A total of 123 patients underwent PD in the Affiliated Hospital of Southwest Medical University from August 2013 to December 2017 were included, including 47 patients with pancreatic head carcinoma and 76 patients with periampullary carcinoma,then were divided into a TMpE group and a Whipple group respectively.The operative time,intraoperative blood loss,postoperative hospitalization time,postoperative recovery time of gastrointestinal function,postoperative complications,and postoperative survival of patients with the same site between the Whipple group and the TMpE group were retrospectively compared.Results ①There were no significant differences in the baseline data between the TMpE group and the Whipple group in the pancreatic head carcinoma and periampullary carcinoma (P>0.05).②For the patients with pancreatic head carcinoma,there were no significant differences in the operative time,postoperative hospitalization time, and postoperative gastrointestinal function recovery time between the TMpE group and the Whipple group (P>0.05),but the intraoperative blood loss in the TMpE group was significantly higher than that in the Whipple group (P=0.038);For the patients with periampullary carcinoma,the above indexes had no significant differences between the TMpE group and the Whipple group (P>0.05).③The total incidence of complications in the TMpE group was significantly higher than that in the Whipple group for the patients with pancreatic head carcinoma (χ2=6.595,P-0.010),which had no significant difference between the TMpE group and the Whipple group for the patients with periampullary carcinoma (P>0.05).④ The cumulative survival curve in the TMpE group was better than that in the Whipple group for the patients with pancreatic head carcinoma (χ2=9.597,P=0.002),which had no significant difference between the TMpE group and the Whipple group for the patients with periampullary carcinoma (χ2=0.844,P=0.358).Conclusions For patients with pancreatic head cancer,comparing with standard Whipple,although TMpE PD increases intraoperative blood loss and overall incidence of complications,it could significantly improve long-term survival and there are no significant differences in postoperative recovery time and operative safety between Whipple and TMpE;For patients with periampullary carcinoma,there are no significant differences in surgical safety,long-term survival rate,and survival time between TMpE and Whipple.