联合血管切除重建在胰腺癌根治术中的临床价值

Clinical value of synangio-excision-restruction in pancreatic cancer radical operation

目的探讨联合血管切除重建的胰腺癌根治术对胰腺癌患者手术并发症、生活质量和生存状况的影响。方法选择四川省德阳市人民医院和川北医学院附属医院2010年1月至2015年10月收治的胰腺癌患者255例,根据手术方式不同将患者分为3组:联合血管切除重建组(A组)41例,无血管切除重建组(B组)113例,姑息性旁路手术组(C组)101例。分析3组患者的临床资料,探讨联合血管切除对患者手术并发症、生活质量和生存状况的影响。结果A组患者术后并发症的发生率为56.10%,明显高于B组(34.51%)和C组(20.79%),差异有统计学意义(P<0.05)。A组腹痛、体质量增加分别为36.59%、51.22%,与C组患者(91.09%、9.09%)比较,差异均有统计学意义(P<0.05)。A组中位生存时间(MST)为11.83月,B组MST为15.43月,C组MST为7.50月;A、C组MST比较差异有统计学意义(χ~2=4.27,P<0.05);A、B组MST比较差异无统计学意义(χ~2=3.67,P>0.05)。结论对于门静脉、肠系膜上静脉受累的胰腺癌患者,通过血管切除重建根治性切除能够明显延长患者的生存时间和改善患者的生活质量。

Objective To investigate the influence of synangio-excision-restruction in pancreatic cancer radical operation on the complications,living quality and survival status in the patients with pancreatic cancer. Methods A total of 255 patients with pancreatic cancer in our hospitals from January 2010 to October 2015 were selected and divided into 3 groups according to different operation modes ： 41 cases in the Synangio-excision-restruction group （A）, 113 cases in the non-synangio-excision-restruction group （B） and 101 cases in the palliative by-pass operation group（C）. The clinical data in 3 groups were analyzed. The influence of Synangio-excision- restruction on operative complications,living quality and survival status was investigated. Results The incidence rate of complications in the group A was 56.10 %, which was obviously higer than 34.51 % in the group B and 20.79 % in the group C, and the difference was statistically significant（P〈0.05）. In the group A, the incidence rates of belly ache and body weight gain were 36.59% and 51.22% respectively,which comparing with 91.09% and 9.09% in the group C showed statistically significant difference（P〈0.05）. The median survival time（MST） in the group A was 11.83 months,which in the group B and C were 15.43 % months and 7.50 months,the difference between the group A and C was statistically slgmfican （χ^2= 4.27, P〈0.05） ;while the difference between the group A and B was not statistically significant（χ^2= 3.67, P〈0.05）. Conclusion For the pancreatic cancer patients with affected portal vein and inferior mesenteric vein,the synangio- excision-restruction radical operation can obviously prolong the patients; survival time and improves their living quality.