新辅助化疗后LPD钩突切除中先动脉后静脉原则的安全性研究

Safety study of the principle of anterior artery and posterior vein in uncinate process resection of LPD after neoadjuvant chemotherapy

目的探讨新辅助化疗(NAC)后腹腔镜胰十二指肠切除术(LPD)钩突切除中先动脉后静脉原则的安全性。方法回顾性分析2018年6月至2023年6月完成NAC后行LPD的136例胰腺癌患者的临床资料,根据钩突切除中入路原则的不同分为研究组(n=74例,采用先动脉后静脉原则)和对照组(n=62例,采用先静脉后动脉的原则)。数据应用软件SPSS 22.0处理。围手术期指标等计量资料采用(x±s)表示,行独立样本t检验;术后并发症等计数资料采用[例(%)]表示,行秩和检验或χ^(2)检验;生存分析采用Kaplan-Meier法并行Log-Rank检验。P<0.05表示差异有统计学意义。结果研究组患者手术时间、钩突离断时间及术中出血量较对照组均显著降低,淋巴结清扫数目及R0切除率显著升高,差异均有统计学意义(P<0.05);两组患者引流管拔除时间及术后住院时间比较,差异均无统计学意义(P>0.05)。研究组患者术后并发症的总发生率低于对照组(17.6%vs.27.4%),但差异无统计学意义(P>0.05)。研究组患者的累积无病生存率(77.0%vs.67.7%)和累积总生存率(79.7%vs.71.0%)均显著高于对照组,差异有统计学意义(P<0.05)。结论NAC后LPD钩突切除中先动脉后静脉原则是安全、有效的,此原则在不增加术后并发症的同时,不仅可有效缩短手术时间、减少术中损伤、提高淋巴结清扫的彻底性和R0切除率,还可提高患者的生存率。

Objective To investigate the safety of the anterior artery and posterior vein principle in laparoscopic pancreaticoduodenectomy(LPD)of uncinate process after neoadjuvant chemotherapy(NAC).Methods The clinical data of 136 patients with pancreatic cancer who underwent LPD after completing NAC from June 2018 to June 2023 were retrospectively analyzed,and were divided into study group(n=74 cases,using the principle of prevenous and then venous)and control group(n=62 cases,using the principle of prevenous and then arterial)according to different approach principles during uncinate process resection.The data was processed by SPSS 22.0.Measurement data such as perioperative indexes were represented by(x±s),and independent sample t test was performed.The statistical data of postoperative complications were represented by[cases(%)],Rank Sum test orχ^(2)test.Kaplan-Meier method and Log-Rank test were used for survival analysis.P<0.05 indicated that the difference was statistically significant.Results The operative time,uncinate process separation time and intraoperative blood loss in the study group were significantly lower than those in the control group,and the number of lymph node dissection and R0 resection rate were significantly increased in the study group,with statistical significance(P<0.05).There was no significant difference in drainage tube removal time and postoperative hospitalization time between the two groups(P>0.05).The total incidence of postoperative complications in the study group was lower than that in the control group(17.6%vs.27.4%),but the difference was not statistically significant(P>0.05).The cumulative disease-free survival rate(77.0%vs.67.7%)and the cumulative overall survival rate(79.7%vs.71.0%)in the study group were significantly higher than those in the control group,with statistical significance(P<0.05).Conclusion The principle of anterior artery and posterior vein resection of uncinate process after NAC is safe and effective.This principle can not only effectively shorten the operation time,reduce intraoperative injury,improve the thoroughness of lymph node dissection and R0 removal rate,but also improve the survival rate of patients without increasing postoperative complications.