后腹膜整块切除扩大清扫术治疗胰腺癌28例疗效分析

Pancreatectomy with en-bloc retroperitoneal clearancefor pancreatic cancer

目的 探讨胰腺癌后腹膜整块切除扩大清扫术（PERC）的安全性和有效性。方法 回顾性分析2014年1月至2015年7月南京医科大学第一附属医院胰腺中心收治的行PERC的28例胰腺癌病人的临床资料。术前影像学评估为可切除或可能切除,术中行联合淋巴组织、脂肪组织、纤维结缔组织及神经组织的后腹膜整块切除扩大清扫,仅保留必要的动静脉。结果 所有28例病人均顺利完成手术,无死亡病例;手术时间为340（150~540）min;术中失血量为400（200~700）m L。术后并发症发生率为42.9%（12/28）。病人术后住院时间为13（8~30）d。清扫淋巴结数为12（5~36）枚。19例病人达到R0切除,9例病人为R1切除。随访12（3~27）个月,4例病人出现局部复发,11例病人出现远处转移;15例病人死亡,其中因肿瘤进展死亡9例,另外6例病人未发现复发和远处转移而死亡;13例存活病人中,6例病人截至末次随访,未发现局部复发和远处转移,目前最长无瘤生存时间为27个月。结论 PERC治疗胰腺癌安全、可行,不增加手术并发症,可提高胰腺癌R0切除率,可望通过减少术后局部复发以改善病人预后。

Objective To investigate the feasibility and safety of pancreatectomy with en-bloc retroperitoneal clearance （PERC） in pancreatic cancer. Methods From Jan. 2014 to Jul. 2015, a total of 28 patients underwent PERC procedure in the First Affiliated Hospital of Nanjing Medical University. After a thorough radiologic assessment, all tumors were considered to be resectable or borderline resectable. Specimen together with retroperitoneal soft tissue containing different stations of lymph nodes （LNs） and nerve plexus were removed en-bloc, only retained the necessary artery and vein. Results Median operative time was 340（150-540）min with estimated median blood loss 400 （200-700）mL. Complications occurred in 12 of 28 patients （42.9%） with no perioperative mortality. Median postoperative hospital stay was 13 （8-30）d. Median number of harvested LNs was 12（5-36）. R0 resection was achieved in 19 （67.86%） of 28 patients. At a median follow-up of 12 （3-27） months, local recurrence occured in 4 patients and distant metastases in 11 patients. 15 of 28 patients （53.57%） are dead, 9 patients death due to tumor progression, 6 patients died without local recurrence and distant metastasis. Among 13 patients still alive, 6 patients was not found local recurrence or distant metastases, the longest disease-free survival time was 27 months until the last time of follow-up. Conclusion PERC is a safe and feasible procedure, which may increase the possibility of R0 resection and improve survival in patients with pancreatic cancer.