中国普外基础与临床杂志

中国普外基础与临床杂志

根治性顺行性模块化胰脾切除术治疗胰体尾癌的初步经验(附 52 例报道)

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目的 总结根治性顺行性模块化胰脾切除手术(RAMPS)治疗胰体尾癌的单中心初步经验。 方法 回顾性分析 2013 年 1 月至 2016 年 12 月期间于新疆医科大学第一附属医院胰腺外科行 RAMPS 手术治疗的 52 例胰体尾癌患者的临床资料。 结果 52 例患者的手术均顺利完成,无住院期间或术后 30 d 内死亡病例。手术时间 198~830 min、(463±137)min;术中出血量 100~2 800 mL,中位数为 400 mL,其中有 19 例(36.5%)术中输血。术后住院时间为 7~58 d,中位时间为 19.5 d。术后发生胰瘘 18 例,胃排空延迟 5 例,腹腔积液 7 例,胸腔积液 3 例,腹腔感染 4 例,腹腔出血 2 例。有 2 例患者接受再手术。术后 51 例患者获访,随访时间 3~35 个月,中位随访时间为 18 个月,所有患者的中位生存时间(MST)为 16.2 个月。随访期间 21 例复发转移,8 例死亡。Cox 比例风险回归模型结果表明,切缘 [RR=3.65,95% CI 为(0.06,5.11),P=0.026] 和辅助治疗 [RR=6.43,95%CI 为(1.51,27.43),P=0.012] 均与预后有关,切缘阴性和行辅助治疗患者的预后较好。 结论 RAMPS 治疗胰体尾癌安全可行,可能提高患者的 R0 切除率,联合辅助治疗有助于改善患者的预后。

Objective To summarize the experience of single center for radical antegrade modular pancreatosplenectomy (RAMPS) in the treatment of pancreatic body and tail cancer. Methods The clinical data of 52 patients with pancreatic body and tail cancer who underwent RAMPS surgery in the First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2016 were retrospectively analyzed. Results All operations of the 52 patients were successfully completed, with no death during hospitalization and 30 days after surgery. The operative time was (463±137) min (198–830 min), the median of intraoperative blood loss was 400 mL (100–2 800 mL), of which 19 cases (36.5%) received intraoperative blood transfusion. The median of hospital stay was 19.5 days (7–58 days). After operation, 18 patients suffered from pancreatic fistula, 5 patients suffered from delay gastric emptying, 7 patients suffered from peritoneal effusion, 3 patients suffered from pleural effusion, 4 patients suffered from abdominal infection, 2 patients suffered from abdominal bleeding. Reoperations were performed in 2 patients. There were 51 patients were followed up for 3–35 months (the median of 18 months) with the median survival time were 16.2 months. During the follow-up period, 21 patients suffered from recurrence or metastasis, of which 8 patients died. The results of Cox partial hazard model showed that, surgical margin [RR=3.65, 95% CI was (0.06, 5.11), P=0.026] and adjuvant therapy [RR=6.43, 95% CI was (1.51, 27.43), P=0.012] were statistically related with prognosis, the prognosis of patients with negative surgical margin and underwent adjuvant therapy were better than those patients with positive surgical margin and didn’t underwent adjuvant therapy. Conclusions RAMPS is safe and feasible in the treatment of pancreatic body and tail cancer, and it may improve the R0 resection rate. RAMPS combins with adjuvant therapy can contribute to better prognosis.

关键词: 胰体尾癌; 根治性顺行模块化胰脾切除术; 预后

Key words: pancreatic body and tail cancer; radical antegrade modular pancreatosplenectomy; prognosis

引用本文: 秦双利, 程坤, 韩玮, 陈启龙, 林海, 何铁英, 徐新建. 根治性顺行性模块化胰脾切除术治疗胰体尾癌的初步经验(附 52 例报道). 中国普外基础与临床杂志, 2018, 25(6): 673-679. doi: 10.7507/1007-9424.201711052 复制

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