腹腔镜胰十二指肠切除术中腹膜后神经清扫在早期胰腺癌中的应用价值

The clinical value of retroperitoneal nerve dissection in laparoscopic pancreatoduodenectomy for early pancreatic cancer

目的探讨腹腔镜胰十二指肠切除术(LPD)中腹膜后神经清扫在早期胰腺癌中的应用价值。方法回顾性分析2018年1月至2019年12月86例行LPD早期胰腺癌患者的临床资料,按照淋巴结清扫范围分为标准组(n=46)和研究组(n=40)。标准组:采用标准的淋巴结清扫;研究组:采用腹膜后神经清扫。数据采用软件SPSS 22.0进行统计学分析。围术期指标等计量资料采用(x±s)表示,行独立t检验;术后并发症等计数资料采用χ^(2)检验分析。生存分析采用Kaplan-Meier法并行Log-rank检验。P<0.05差异有统计学意义。结果与标准组相比,研究组患者的手术时间、术中出血量、淋巴结清扫数目、阳性淋巴结检出数及R0切除率较标准组均显著提高(P<0.05);而两组患者的术后住院时间及术后总并发症的发生率差异无统计学意义(P>0.05);随访期间,术后1年无病生存率标准组患者为69.6%,研究组患者为87.5%,两组差异有统计学意义(χ^(2)=3.998,P=0.046)。结论LPD联合神经清扫治疗早期胰腺癌虽然使手术时间有所延长且术中出血量也有所增加,但提高了患者的R0切除率和术后1年无病生存率。

Objective To investigate the clinical value of retroperitoneal nerve dissection in laparoscopic pancreaticoduodenectomy(LPD)in the treatment of early pancreatic cancer.Methods The clinical data of 86 patients with early pancreatic cancer who underwent LPD from January 2018 to December 2019 were analyzed retrospectively.And according to the scope of lymph node dissection,46 cases were divided into the standard group received standard lymph node dissection,while 40 cases were divided into the study group received retroperitoneal nerve dissection.Statistical analysis were performed by using SPSS 22.0 software Measurement data such as perioperative indexes were expressed as,and were examined by using t-test.Count data such as postoperative complications were examined by usingχ^(2) test.The survival were analyzed by using Kaplan-Meier method and parallel log-rank test.A P value of<0.05 was considered as statistically significant difference.Results Compared with the standard group,much longer operation time,more intraoperative blood loss and harvested lymph nodes,and increased number of positive lymph nodes detected and R0 resection rate were observed respectively in the study group(P<0.05);There was no significant difference between two groups in terms of the length of hospitalization and the incidence of complications(P>0.05);During the follow-up,the 1-year disease-free survival rate of 87.5%in the study group was significantly higher than 69.6%in the standard group(χ^(2)=3.998,P=0.046).Conclusion Although LPD combined with nerve dissection in the treatment of early pancreatic cancer would increase the operation time and blood loss,it could improve the R0 resection rate and the 1-year disease-free survival rate.