腹腔镜胰十二指肠切除术中第14c/d组淋巴结清扫在胰头癌中的临床效果研究

Clinical effect of 14c/d group lymph node dissection during laparoscopic pancreaticoduodenectomy in patients withpancreaticheadcancer

目的研究腹腔镜胰十二指肠切除术(LPD)中第14c/d组淋巴结清扫在胰头癌中的临床效果。方法回顾性分析2019年9月至2023年9月行LPD的46例胰头癌患者的临床资料,根据术中是否对第14c/d组淋巴结进行清扫分为清扫组(n=24例)和未清扫组(n=22例)。未清扫组参照《中国胰腺癌诊治指南(2021)》行标准淋巴结清扫范围的LPD;清扫组在未清扫组的基础上清扫第14c/d组淋巴结。采用SPSS25.0统计学软件分析数据。并发症等计数资料用[例(%)]表示,行x或秩和检验;手术相关指标等计量资料用(x±s)表示,组间比较行独立样本t检验;使用Kaplan-Meier法绘制生存曲线,行Log-Rank检验。P<0.05为差异有统计学意义。结果清扫组和未清扫组患者在手术时间、出血量、胃肠功能恢复时间及术后住院时间上比较差异均无统计学意义(P>0.05);清扫组患者清扫淋巴结枚数、检出阳性淋巴结枚数及R0切除率均显著高于未清扫组(P<0.05);清扫组患者术后并发症总发生率虽高于未清扫组(37.5%Us.27.3%),但差异未见统计学意义(P>0.05);清扫组患者较未清扫组的累积总生存率(70.8%us.59.1%)和无病生存率(62.5%us.50.0%)均显著升高(Log-RankX=4.172、4.023,P=0.041、0.045)。结论LPD中第14c/d组淋巴结清扫在胰头癌中是安全、可行的,在不显著增加术后并发症的同时,可使淋巴结清扫更彻底,提高了肿瘤的根治性,并改善了患者的预后。

Objective To investigate the clinical effect of laparoscopic pancreaticoduodenectomy(LPD)in the treatment of pancreatic head cancer with lymph node dissection in group 14c/d.MethodsThe clinical data of 46 patients with pancreatic head cancer who underwent LPD from September 2019 to September 2023 were retrospectively analyzed.According to whether lymph nodes in group 14c/d were dissected during operation,they were divided into the dissected group(n=24 cases)and the undissected group(n=22 cases).In the non-dissected group,LPD in the standard lymph node dissection range was performed according to the Chinese Guidelines for Diagnosis and Treatment of Pancreatic Cancer(2021).Lymph nodes of group 14c/d were cleaned in the cleaning group on the basis of the non-cleaning group.SPSS 25.0 statistical software was used to analyze the data.The statistical data of complications were expressed by[cases(%)]and X or Rank Sum test was performed.Measurement data such as surgery-related indicators were represented by(x±s),and independent sample t test was performed for inter-group comparison.The survival curve was drawn by Kaplan-Meier method and tested by Log-Rank.P<0.05 was considered statistically significant.ResultsThere were no significant differences in operation time,blood loss,gastrointestinal function recovery time and postoperative hospital stay between the two groups(P>0.05).The number of lymph nodes cleared,the number of positive lymph nodes detected and the RO resection rate in the dissection group were significantly higher than those in the non-dissection group(P<0.05).The total incidence of postoperative complications in the sweeping group was higher than that in the non-sweeping group(37.5%us.27.3%),but the difference was not statistically significant(P>0.05).The cumulative overall survival rate(70.8%vs.59.1%)and diseasefree survival rate(62.5%us.50.0%)in the swept group were significantly higher than those in the non-swept group(Log-Rank x^(2)=4.172,4.023,P=0.041,0.045).Conclusion Lymph node dissection in group 14c/d of LPD is safe and feasible in pancreatic head cancer.It can make lymph node dissection more thorough without significantly increasing postoperative complications,improve the radical treatment of tumors,and improve the prognosis of patients.