文章摘要
杜波,周泉宇*,王志旭,甘元涛.根治性顺行模块化胰脾切除术治疗胰腺体尾部腺癌患者临床分析[J].中国医药导刊,2019,21(7):400-404.
根治性顺行模块化胰脾切除术治疗胰腺体尾部腺癌患者临床分析
Clinical Analysis of Radical Antegrade Modular Pancreatosplenectomy for Left-sided Pancreatic Adenocarcinoma
投稿时间:2019-04-21  修订日期:2019-06-04
DOI:
中文关键词: 胰腺体尾部肿瘤  根治性顺行模块化胰脾切除术  经验分析
英文关键词: Left-sided pancreatic adenocarcinoma  Radical antegrade modular pancreatosplenectomy  Experience analysis
基金项目:
作者单位E-mail
杜波 乐山市人民医院肝胆胰脾外科 leitseha@126.com 
周泉宇* 乐山市人民医院肝胆胰脾外科 1652540230@qq.com 
王志旭 乐山市人民医院肝胆胰脾外科  
甘元涛 乐山市人民医院肝胆胰脾外科  
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中文摘要:
      目的:探究根治性顺行模块化胰脾切除术(RAMPS)治疗胰腺体尾部腺癌的安全性及可行性。方法:回顾性分析2016年1月1日至2018年12月31日在我院肝胆胰脾外科就诊的20例胰腺体尾部腺癌患者的临床资料。回顾性分析患者的年龄、性别、手术情况(手术时间、手术类型、术中出血)、肿瘤特征(肿瘤分化程度、肿瘤大小、淋巴结清除情况、TNM分期)等相关临床病理资料。采用门诊或电话的方式进行随访,随访患者的生存、肿瘤复发及转移情况。结果:20例患者均顺利完成手术,1例患者因肿瘤弥漫性浸润遂行Roux-Y胃空肠吻合姑息性手术。手术平均时间为(356.35±135.68)min,术中平均出血量(250±70)mL,仅1例患者术中输血。联合血管切除2例,联合脏器切除2例。肿瘤平均直径为(4.12±2.11)cm,病理学类型均为胰腺腺癌。淋巴结清扫数目为(21.82±10.13)枚;淋巴结阳性14例,阳性率为70%。16例患者获得R0切除。患者中位生存时间为22.5个月,随访时间为(23.07±13.23)个月。术后5例患者出现并发症,无术后死亡,其中A级胰瘘1例、B级胰瘘2例,出血1例,尿潴留1例。无患者发生腹泻、肠梗阻等消化道并发症。单因素分析显示肿瘤分化、R0切除、胰瘘、术后综合治疗对患者远期生存率均有统计学意义(P<0.05)。结论:RAMPS可以为局部晚期胰腺癌合并器官侵犯患者,提供更多的局部治疗和根治性切除机会。
英文摘要:
      Objective: To evaluate the safety and feasibility of radical antegrade modular pancreatosplenectomy (RAMPS) for left-sided pancreatic adenocarcinoma. Methods: Clinical data of total 20 patients underwent RAMPS for left-sided pancreatic adenocarcinoma at department of hepatobiliary and pancreatic surgery in our hospital from January 2016 to December 2018 were reviewed retrospectively. Retrospective analysis of the patient′s age, sex, intraoperative conditions (operation time, surgical type, intraoperative bleeding), tumor characteristics (tumor differentiation, tumor size, lymph node clearance, TNM staging) and other related clinicopathological data was made. The follow-up using outpatient examination or telephone review was performed to detect the patients’ survival and tumor recurrence and metastasis. Results: The operation was successfully completed in 20 patients and palliative operation was performed in 1 patient due to diffuse infiltration of tumor. The mean operative time was (356.35±135.68) min, and the mean blood loss was (250±70) mL. Only one patient required blood transfusion during surgery. Combined vascular resection was performed in 2 cases, and combined organ resection was performed in 2 cases. The mean diameter of tumor was (4.12±2.11) cm. The pathological types were all pancreatic adenocarcinoma. The mean number of retrieved lymph nodes was (21.82±10.13) and node positivity was observed in 14 patients (70%). Negative tangential margins were obtained in 16 patients. In this study, the median survival time was 22.5 months with a median follow-up period of (23.07±13.23) months. Five patients had postoperative complications. One patient had grade A fistula and two had grade B fistula; one case of hemorrhage; one case of urinary retention. No patient occurred diarrhea, intestinal obstruction and other gastrointestinal complications. Univariate analysis showed that tumor differentiation, R0 resection, pancreatic fistula and postoperative comprehensive treatment had statistically significance on long-term survival rate(P<0.05). Conclusion:RAMPS can provide more local treatment and radical resection opportunities for patients with locally advanced pancreatic cancer and organ invasion.
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