摘要
目的评价同种异体静脉置换术在交界可切除胰腺癌中应用的效果,并分析导致术后置换血管中重度狭窄的危险因素。方法回顾性分析2013年1月至2021年12月在首都医科大学附属北京朝阳医院肝胆外科行手术治疗的77例交界可切除胰腺癌患者的临床资料,其中男性34例,女性43例,年龄(61.4±10.8)岁。分析患者的围手术期资料、术后置换血管狭窄情况、术后生存情况。采用门诊复查和电话相结合的方式进行随访。Cox比例风险模型分析导致置换血管发生中重度狭窄的可能危险因素。结果77例患者中,交界可切除胰腺癌侵犯门静脉系统汇合部41例,侵犯肠系膜上静脉22例,侵犯门静脉14例,受侵静脉切除长度(3.7±1.0)cm,肿瘤长径(3.8±1.6)cm,淋巴结转移57例,R0切除70例,术后并发症发生率为29.9%(23/77)。患者术后6个月、1年、2年的生存率分别为84.1%、52.3%、32.9%。随访期间,77例患者发生置换血管轻度狭窄4例(5.2%),中度狭窄9例(11.7%),重度狭窄11例(14.3%)。多因素Cox回归分析结果显示,血管切除长度>3 cm(RR=4.602,95%CI:1.657~12.781,P=0.003)和肿瘤复发(RR=8.529,95%CI:1.129~64.448,P=0.038)是同种异体静脉置换术后置换血管发生中重度狭窄的独立危险因素。结论同种异体静脉用于交界可切除胰腺癌术中门静脉系统重建是安全可行的,术后置换血管发生中重度狭窄的原因可能与血管切除长度>3 cm和肿瘤复发有关。
Objective To evaluate the effect of allogenic vein replacement in treatment of borderline resectable pancreatic cancer,and to analyze risk factors of long-term stenosis.Methods The clinical data of 77 patients with borderline resectable pancreatic cancer who underwent surgery from January 2013 to December 2021 at the Beijing Chaoyang Hospital,Capital Medical University were retrospectively analyzed.There were 34 males and 43 females,aged(61.4±10.8)years old.The peri-operative data,long-term prognosis and stenosis of allogenic vein were analysed.Risk factors of stenosis were analyzed by the Cox proportional hazards model.Patients were followed up by outpatient visits or by telephone.Results Pancreatic cancer had invaded the junction of portal vein/superior mesenteric vein(SMV)in 41 patients,SMV in 22 patients and portal vein in 14 patients.The length of venous resection was(3.7±1.0)cm,the tumor longest diameter was(3.8±1.6)cm,lymph node metastasis was present in 57 patients,R0 resection was carried out in 70 patients,and the postoperative complication rate was 29.9%(23/77).The survival rates in 6 months,1-year and 2-year were 84.1%,52.3%and 32.9%respectively.Mild venous stenosis occurred in 4 patients(5.2%),moderate stenosis in 9 patients(11.7%)and severe stenosis in 11 patients(14.3%).A vascular resection length of more than 3 cm(RR=4.602,95%CI:1.657-12.781,P=0.003)and tumor recurrence(RR=8.529,95%CI:1.129-64.448,P=0.038)were independent risk factors for long-term moderate and severe stenosis of allogeneic vein.Conclusion It was safe and feasible for allogenic vein to be used to reconstruct the portal venous system in resection of borderline resectable pancreatic cancer.Long-term stenosis of the allogenic vein was related to a length of vascular resection of more than 3 cm and recurrence of tumor.
作者
吕少诚
贺强
郎韧
樊华
李立新
李先亮
寇建涛
刘煜
Lyu Shaocheng;He Qiang;Lang Ren;Fan Hua;Li Lixin;Li Xianliang;Kou Jiantao;Liu Yu(Department of Hepatobiliary Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2022年第8期576-581,共6页
Chinese Journal of Hepatobiliary Surgery
基金
首都临床诊疗技术研究及转化应用(Z211100002921025)。
关键词
胰腺肿瘤
胰腺切除术
预后
血管侵犯
异体血管
狭窄
Pancreatic neoplasms
Pancreatectomy
Prognosis
Vascular invasion
Allogeneic vessel
Stenosis