全系膜切除理念在胰头癌根治术中的应用与研究进展

Application and progress of total mesopancrease excision in radical resection of pancreatic head cancer

胰腺癌是常见消化道恶性肿瘤之一,发病率呈上升趋势,目前根治性手术仍是其获得治愈的主要手段。但由于临床实践中胰头癌的实际R0切除率不高,术后局部复发率较高,预后不佳,因此国内外学者提出了胰腺全系膜切除理念,并进行了一系列相关临床与基础研究,虽然就全系膜的定义、切除范围、临床预后等伴随着各种争议与讨论,但是从现有相关研究来看,全系膜切除理念具有组织胚胎与解剖学依据,具备外科实践的可行性与围手术期安全性,可以有效提高R0切除率,降低局部复发率,并改善预后。同时,转化医学、纳米科技、可视化技术、人工智能、微创外科等外科学的新兴领域与交叉学科的研究都涉及了全系膜切除理念的应用。相信随着胰头癌全系膜理念的进一步广泛研究及探索性应用,使大样本多中心的临床研究将得以实现,从而提供可靠的临床评价证据,并可能最终达成胰头癌全系膜切除的定义、切除范围、应用指征的共识,成为胰头癌外科治疗中一项新的、有意义的技术理念。

Pancreatic cancer is one of the most common digestive malignant tumors with a incidence rate on the rise in recent years,and radical surgery is still the main means of treatment to obtain a cure.However,in clinical practice,the actual R0 resection rate of pancreatic head cancer is not high,the postoperative local recurrence rate is high,and the prognosis is poor.Therefore,domestic and foreign scholars have proposed the concept of total mesopancreatectomy,and conducted a series of related clinical and basic research.Although the definition,resection range and clinical prognosis of total mesentery are accompanied by various controversies and discussions,from the existing relevant research,the concept of total mesentery resection has the basis of tissue embryo and anatomy,with the feasibility of surgical practice and perioperative safety,can effectively improve the R0 resection rate,reduce the local recurrence rate,and improve the prognosis.At the same time,the concept of TMpE is also used in the emerging fields,such as translational medicine,nanomedicine,visualization technology,artificial intelligence,minimally invasive surgery.We believe that with the further extensive research and exploratory application of the concept of total mesentery of pancreatic head cancer,the clinical study of large sample and multi-center will be realized,so as to provide reliable clinical evaluation evidence,and may eventually reach the consensus of definition,resection range and application indications of total mesentery resection of pancreatic head cancer,and become a new and meaningful technical concept in the surgical treatment of pancreatic head cancer.