全胰切除术对胰腺肿瘤的近远期疗效分析

Short-and long-term therapeutic effects of total pancreatectomy in pancreatic tumors

目的探讨全胰切除术(TP)在胰腺肿瘤患者中的近远期疗效。方法回顾性纳入2005年6月至2018年3月复旦大学附属中山医院43例TP患者,分析其临床病理特征、手术情况、术后并发症及总生存期。结果本组共43例,其中胰腺导管腺癌(PDAC)25例,胰腺导管内乳头状黏液瘤(IPMN)14例,实性假乳头状瘤2例,腺鳞癌1例,神经内分泌肿瘤(NET)1例。并发症发生率为76.7%,30 d病死率为7.0%,中位生存期为20.0个月。与PDAC组比较,IPMN组患者输血率(21.4%vs 60.0%,P=0.043)、联合血管切除率(21.4%vs 64.0%,P=0.019)和腹腔感染率(0 vs 32.0%,P=0.034)均较低,且术后住院时间较短(11.5 d vs23.0 d,P=0.004)。进一步分析表明,浸润性IPMN患者在TP术后获得了更长的远期生存(35.8个月vs 15.0个月,P=0.033)。结论TP术式安全可行且在部分病例中能获得良好的肿瘤学效果,IPMN可能是较PDAC更优选的手术适应证。

objective To analyze the short-and long-term therapeutic effects of total pancreatectomy(TP)in pancreatic tumor patients.Methods Forty-three patients underwent TP in Zhongshan Hospital,Fudan University from Jun.2005 to Mar.2018 were retrospectively included.Investigations on clinicopathological characteristics,operative details,postoperative outcomes and long-term survival of TP patients were performed.Results The pathological types included pancreatic ductal adenocarcinoma(PDAC,n=25),intraductal papillary mucinous neoplasm(IPMN,n=14),solid pseudopapillary tumor(n=2),adenosquamous carcinoma(n=1)and neuroendocrine tumor(n=1).The complication rate after TP was 76.7%with a 30-day mortality rate of 7.0%,and the median overall survival of the cohort was 20.0 months.Comparative analysis between the PDAC and IPMN groups showed the IPMN patients were associated with lower transfusion(21.4%vs 60.0%,P=0.043),vascular resection(21.4%vs 64.0%,P=0.019)and intra-abdominal infection rates(0 vs 32.0%,P=0.034)and shorter postoperative hospital stays(11.5 d vs 23.0 d,P=0.004).Further analysis indicated the invasive IPMN patients acquired better long-term survival after TP(35.8 months vs 15.0 months,P=0.033).Conclusion TP is feasible and could achieve good oncological outcomes when applied to selected patients,and IPMN could be superior to PDAC as an indication for this procedure.