CAJ | 학술논문

目的研究胰头癌淋巴转移的特点及其临床病理影响因素,为胰头癌手术合理的淋巴清扫提供理论依据.同时,验证手术显微镜法在胰头癌根治性切除标本中淋巴结检出的可靠性和有效性.方法根据日本胰腺学会制定的胰头癌淋巴结分组标准,对150例胰头癌根治性手术(胰十二指肠切除+D2区域性淋巴结清扫)标本,应用已建立的手术显微镜法进行标本淋巴结检查,研究胰头癌转移淋巴结的分布、各组淋巴结转移发生频率和可能的影响因素；并将研究结果与2004年46例标本结果进行对比,进一步验证并分析手术显微镜法淋巴结转移检出的有效性.结果经病理证实,150例患者均为胰头导管腺癌,手术显微镜法每例找到淋巴结数平均为38.2枚,其中101例有淋巴结转移(淋巴结转移发生率为67.3％).转移频率较高的淋巴结组有第13组(64.5％)、14组(51.7％)、17组(38.6％)、12组(25.8％)和16组(20.8％).研究表明肿瘤大小、局部浸润、分化程度以及术前糖类抗原19-9和糖类抗原72-4水平与胰腺癌的淋巴结转移密切相关,而与患者性别、年龄和肿瘤部位没有明显的相关性.每例标本获取的平均淋巴结数、淋巴结转移发生率、各组淋巴结的转移频率与2004年的研究结果无明显差异,说明手术显微镜法是一稳定有效的胰腺癌淋巴结检出方法.结论可切除胰头癌患者存在较为广泛的淋巴结转移,应该进行根治性的淋巴清扫,以减少术后淋巴结转移的发生.手术显微镜法是一种稳定有效的胰腺癌淋巴结检出方法,有助于获取胰腺癌淋巴结转移研究所需的信息和准确的临床病理分期.
목적 연구이두암림파전이적특점급기림상병리영향인소,위이두암수술합리적림파청소제공이론의거.동시,험증수술현미경법재이두암근치성절제표본중림파결검출적가고성화유효성.방법 근거일본이선학회제정적이두암림파결분조표준,대150례이두암근치성수술(이십이지장절제+D2구역성림파결청소)표본,응용이건립적수술현미경법진행표본림파결검사,연구이두암전이림파결적분포、각조림파결전이발생빈솔화가능적영향인소；병장연구결과여2004년46례표본결과진행대비,진일보험증병분석수술현미경법림파결전이검출적유효성.결과 경병리증실,150례환자균위이두도관선암,수술현미경법매례조도림파결수평균위38.2매,기중101례유림파결전이(림파결전이발생솔위67.3％).전이빈솔교고적림파결조유제13조(64.5％)、14조(51.7％)、17조(38.6％)、12조(25.8％)화16조(20.8％).연구표명종류대소、국부침윤、분화정도이급술전당류항원19-9화당류항원72-4수평여이선암적림파결전이밀절상관,이여환자성별、년령화종류부위몰유명현적상관성.매례표본획취적평균림파결수、림파결전이발생솔、각조림파결적전이빈솔여2004년적연구결과무명현차이,설명수술현미경법시일은정유효적이선암림파결검출방법.결론 가절제이두암환자존재교위엄범적림파결전이,응해진행근치성적림파청소,이감소술후림파결전이적발생.수술현미경법시일충은정유효적이선암림파결검출방법,유조우획취이선암림파결전이연구소수적신식화준학적림상병리분기.
Objective To study the characteristics and the impact of lymph node metastasis on radical resection for pancreatic head cancer to provide a theoretical basis for lymphadenectomy in radical resection.To study the reliability of using a surgical microscope to detect lymph nodes in radically resected specimens of pancreatic head cancer.Methods Lymph nodes in the specimens after radical pancreaticoduodeneetomy (pancreaticoduodenectomy + D2 regional lymphadenectomy) were identified using a surgical microscope and they were grouped using the JPS standard.The position and the frequency of the lymph nodes retrieved,and their association with other clinicopathologic factors were analysed.The results were compared with the data published in 2004 on 46 patients to evaluate the reliability of using a surgical microscope.Results Lymph node metastasis was detected histopathologically in 101 patients (67.3％).The median number of lymph nodes retrieved in the specimens as detected using the surgical microscope was 38.2.The most commonly involved lymph node groups were No.13 (64.5％),No.14 (51.7％),No.17 (38.6％),No.12 (25.8％),No.16 (20.8％).Lymph node metastasis was significantly associated with tumour T stage,tumour invasion and differentiation,preoperative serum level of CA19-9 and CA72-4,but not with patient age,sex,or tumour location.There were no significant differences between the results and the data of the previous study in 2004.Conclusions Extended lymphadenectomy is necessary because extensive lymph node metastasis was common.Surgical microscopy is an effective and reliable method to detect lymph nodes in resected specimens of pancreatic head cancer for accurate pathologic staging.