腹膜后淋巴脂肪板层根治性切除术在可切除性胰头癌治疗中的临床价值再探讨

The clinical value of radical resection of retroperitoneal lipo-lymphatic layer for pancreatic head cancer

目的:进一步探讨胰头癌行腹膜后淋巴脂肪板层根治性切除术(RRRLLL)的临床应用价值。方法:回顾性收集2020年6月至2022年6月中国5家胰腺中心收治的术中采用RRRLLL治疗的221例可切除性胰头癌患者资料(RRRLLL组)和采用传统清扫技术治疗的107例可切除性胰头癌患者资料(传统组)。RRRLLL组患者中,男性144例,女性77例,年龄(67.5±9.0)岁(范围:41.3~81.1岁)。传统组患者中,男性71例,女性36例,年龄(66.3±8.1)岁(范围:45.1~79.2岁)。通过K-S检验、Z检验或χ^(2)检验对组间数据进行统计分析。结果:RRRLL组手术要求自下腔静脉右侧缘开始向左侧游离后腹膜组织,上至腹腔干上方,下至肠系膜下动脉,左至腹主动脉左侧,包括肠系膜上动脉周围神经丛和淋巴组织及肠系膜动脉鞘。而传统组清扫范围则不包括上述区域。RRRLLL组和传统组患者的年龄、性别分布、肿瘤最大径、T分期、血管侵犯方面的差异均无统计学意义(P值均>0.05)。RRRLLL组清扫淋巴结数量为(28.7±9.0)枚(范围:18~39枚),传统组为(18.2±8.0)枚(范围:12~21枚),差异有统计学意义(Z=-10.691,P<0.05)。两组术后阳性淋巴结数量、N分期及术后并发症发生情况的差异均无统计学意义(P值均>0.05)。结论:RRRLLL可在一定程度上提高胰头癌手术的彻底性,提高后腹膜淋巴结的清除率。

Objective To investigate the clinical value of the novel approach,radical resection of the retroperitoneal lipo-lymphatic layer(RRRLLL),in the surgical treatment of resectable pancreatic head cancer.Methods Between June 2020 and June 2022,a total of 221 patients with pancreatic head cancer underwent surgical treatment using the RRRLLL approach(RRRLLL group),while 107 patients received traditional surgical treatment(traditional group)in five high-volume pancreatic centers in China.Data from surgical technique and clinical perioperative outcomes,including lymph node harvested,surgical time,and complications,were analyzed.The RRRLLL group consisted of 144 males and 77 females with an age of(67.5±9.0)years(range:41.3 to 81.1 years).The traditional group included 71 males and 36 females,with an age of(66.3±8.1)years(range:45.1 to 79.2 years).Statistical analysis was performed using the K-S test,Z test,orχ^(2) test,respectively.Results Pancreaticoduodenectomy was performed successfully in all patients,achieving R0 resection.RRRLLL group surgery required mobilization of retroperitoneal adipose and lymphatic tissues starting from the right edge of the inferior vena cava and extending to the left side,up to the superior mesenteric artery,down to the inferior mesenteric artery,and left to the left side of the aorta,including the perineural and lymphatic tissues around the superior mesenteric artery and the sheath of the mesenteric artery.However,the traditional group did not include the areas mentioned above in the scope of clearance.There were no statistically significant differences between the RRRLLL group and the traditional group in terms of age,sex,tumor size,T stage,and vascular invasion(all P>0.05).However,the number of lymph nodes harvested in the RRRLLL group was significantly higher at 28.7±9.0(range:18 to 39)compared to 18.2±8.0(range:12 to 21)in the traditional group(Z=-10.691,P<0.05).There were no statistically significant differences in the number of positive lymph nodes,N staging,and postoperative complications between the two groups.Conclusion The RRRLLL approach improved lymph node dissection compared to the traditional approach,potentially leading to reduced recurrence rates.