胰头癌R0切除时手术切缘的界定及影响因素

R0 resection of pancreatic head carcinoma: Definition of surgical margins and influencing factors

胰头癌早期诊断困难,确诊时常已发展至晚期,预后差,5年生存率不超过6%.R0切除是胰头癌患者可能获得长期生存机会的唯一方法.大量临床研究表明,腹膜后组织清扫范围不够是胰头癌患者无法达到R0切除的重要原因.胰腺系膜和胰腺全系膜切除(total mesopancreas excision,TMpE)概念的提出更好地定义了手术中腹膜后的清扫范围,从而更有效地提高了R0切除率.

Early diagnosis of pancreatic head carcinoma is difficult. Once diagnosed, it often has been in the advanced stage, the prognosis is poor, and five-year survival does not exceed 6%. R0 resection is the only way to obtain longterm survival in patients with pancreatic head cancer. Numerous clinical studies have shown that lack of retroperitoneal tissue dissection is the important reason for being unable to achieve R0 resection in pancreatic cancer patients. The proposed mesopancreas and total mesopancreas excision（TMp E） concept provides a better definition of retroperitoneal dissection, thereby increasing the rate of R0 resection effectively.