目的 探讨联合血管切除重建的胰十二指肠切除术治疗胰腺癌的临床意义.方法 回顾性分析2006年1月至2011年12月第三军医大学西南医院收治的231例行胰十二指肠切除术胰腺癌患者的临床资料.根据手术方式不同将患者分为联合血管切除重建组(97例)和无血管切除重建组(134例),比较两组患者的手术情况、病理检查结果、患者预后以及淋巴结转移对两组患者预后的影响.计量资料采用两独立样本t检验,计数资料采用x2检验.采用Kaplan-Meier法绘制生存曲线,生存分析采用Log-rank检验.结果 联合血管切除重建组及无血管切除重建组手术时间分别为(554±136) min和(445±106) min,术中出血量分别为(1110 ±939) ml和(623±349)ml,两组比较,差异有统计学意义(t=6.552,4.873,P＜0.05).联合血管切除重建组和无血管切除重建组患者病死率分别为8.2％(8/97)和3.0％ (4/134),两组比较,差异无统计学意义(x2=3.164,P＞0.05).联合血管切除重建组和无血管切除重建组患者术后并发症发生率分别为20.6％ (20/97)和8.2％ (11/134),两组比较,差异有统计学意义(x2=7.458,P＜0.05).联合血管切除重建组和无血管切除重建组患者淋巴结阳性率分别为32.0％(31/97)和16.4％ (22/134),两组比较,差异有统计学意义(x2=7.687,P＜0.05).随访至2012年9月,223例患者获得随访,其中有淋巴结转移者53例,中位生存时间为8.4个月(6.9～10.0个月)；无淋巴结转移者170例,中位生存时间为18.6个月(15.8 ～21.5个月),两者比较,差异有统计学意义(x2=17.045,P＜0.05).53例有淋巴结转移的患者中,联合血管切除重建组31例,中位生存时间为8.5个月(6.3～10.7个月),无血管切除重建组22例,中位生存时间为8.3个月(6.1 ～10.5个月),两组生存情况比较,差异无统计学意义(x2=0.022,P＞0.05).170例无淋巴结转移的患者中,联合血管切除重建组64例,中位生存时间为13.2个月(9.2～17.1个月),无血管切除重建组106例,中位生存时间为21.7个月(18.1～25.3个月),两组生存情况比较,差异有统计学意义(x2=11.908,P＜0.05).结论 联合血管切除重建的胰十二指肠切除术增加了患者术后并发症发生率,但是可以做到完整切除肿瘤,且没有明显增加患者病死率,对有淋巴结转移的胰腺癌患者术后生存时间无显著影响,对无淋巴结转移患者预后可能有一定影响.
目的 探討聯閤血管切除重建的胰十二指腸切除術治療胰腺癌的臨床意義.方法 迴顧性分析2006年1月至2011年12月第三軍醫大學西南醫院收治的231例行胰十二指腸切除術胰腺癌患者的臨床資料.根據手術方式不同將患者分為聯閤血管切除重建組(97例)和無血管切除重建組(134例),比較兩組患者的手術情況、病理檢查結果、患者預後以及淋巴結轉移對兩組患者預後的影響.計量資料採用兩獨立樣本t檢驗,計數資料採用x2檢驗.採用Kaplan-Meier法繪製生存麯線,生存分析採用Log-rank檢驗.結果 聯閤血管切除重建組及無血管切除重建組手術時間分彆為(554±136) min和(445±106) min,術中齣血量分彆為(1110 ±939) ml和(623±349)ml,兩組比較,差異有統計學意義(t=6.552,4.873,P＜0.05).聯閤血管切除重建組和無血管切除重建組患者病死率分彆為8.2％(8/97)和3.0％ (4/134),兩組比較,差異無統計學意義(x2=3.164,P＞0.05).聯閤血管切除重建組和無血管切除重建組患者術後併髮癥髮生率分彆為20.6％ (20/97)和8.2％ (11/134),兩組比較,差異有統計學意義(x2=7.458,P＜0.05).聯閤血管切除重建組和無血管切除重建組患者淋巴結暘性率分彆為32.0％(31/97)和16.4％ (22/134),兩組比較,差異有統計學意義(x2=7.687,P＜0.05).隨訪至2012年9月,223例患者穫得隨訪,其中有淋巴結轉移者53例,中位生存時間為8.4箇月(6.9～10.0箇月)；無淋巴結轉移者170例,中位生存時間為18.6箇月(15.8 ～21.5箇月),兩者比較,差異有統計學意義(x2=17.045,P＜0.05).53例有淋巴結轉移的患者中,聯閤血管切除重建組31例,中位生存時間為8.5箇月(6.3～10.7箇月),無血管切除重建組22例,中位生存時間為8.3箇月(6.1 ～10.5箇月),兩組生存情況比較,差異無統計學意義(x2=0.022,P＞0.05).170例無淋巴結轉移的患者中,聯閤血管切除重建組64例,中位生存時間為13.2箇月(9.2～17.1箇月),無血管切除重建組106例,中位生存時間為21.7箇月(18.1～25.3箇月),兩組生存情況比較,差異有統計學意義(x2=11.908,P＜0.05).結論 聯閤血管切除重建的胰十二指腸切除術增加瞭患者術後併髮癥髮生率,但是可以做到完整切除腫瘤,且沒有明顯增加患者病死率,對有淋巴結轉移的胰腺癌患者術後生存時間無顯著影響,對無淋巴結轉移患者預後可能有一定影響.
목적 탐토연합혈관절제중건적이십이지장절제술치료이선암적림상의의.방법 회고성분석2006년1월지2011년12월제삼군의대학서남의원수치적231례행이십이지장절제술이선암환자적림상자료.근거수술방식불동장환자분위연합혈관절제중건조(97례)화무혈관절제중건조(134례),비교량조환자적수술정황、병리검사결과、환자예후이급림파결전이대량조환자예후적영향.계량자료채용량독립양본t검험,계수자료채용x2검험.채용Kaplan-Meier법회제생존곡선,생존분석채용Log-rank검험.결과 연합혈관절제중건조급무혈관절제중건조수술시간분별위(554±136) min화(445±106) min,술중출혈량분별위(1110 ±939) ml화(623±349)ml,량조비교,차이유통계학의의(t=6.552,4.873,P＜0.05).연합혈관절제중건조화무혈관절제중건조환자병사솔분별위8.2％(8/97)화3.0％ (4/134),량조비교,차이무통계학의의(x2=3.164,P＞0.05).연합혈관절제중건조화무혈관절제중건조환자술후병발증발생솔분별위20.6％ (20/97)화8.2％ (11/134),량조비교,차이유통계학의의(x2=7.458,P＜0.05).연합혈관절제중건조화무혈관절제중건조환자림파결양성솔분별위32.0％(31/97)화16.4％ (22/134),량조비교,차이유통계학의의(x2=7.687,P＜0.05).수방지2012년9월,223례환자획득수방,기중유림파결전이자53례,중위생존시간위8.4개월(6.9～10.0개월)；무림파결전이자170례,중위생존시간위18.6개월(15.8 ～21.5개월),량자비교,차이유통계학의의(x2=17.045,P＜0.05).53례유림파결전이적환자중,연합혈관절제중건조31례,중위생존시간위8.5개월(6.3～10.7개월),무혈관절제중건조22례,중위생존시간위8.3개월(6.1 ～10.5개월),량조생존정황비교,차이무통계학의의(x2=0.022,P＞0.05).170례무림파결전이적환자중,연합혈관절제중건조64례,중위생존시간위13.2개월(9.2～17.1개월),무혈관절제중건조106례,중위생존시간위21.7개월(18.1～25.3개월),량조생존정황비교,차이유통계학의의(x2=11.908,P＜0.05).결론 연합혈관절제중건적이십이지장절제술증가료환자술후병발증발생솔,단시가이주도완정절제종류,차몰유명현증가환자병사솔,대유림파결전이적이선암환자술후생존시간무현저영향,대무림파결전이환자예후가능유일정영향.
Objective To investigate the significance of combined vascular resection and reconstruction in surgery for pancreatic cancer.Methods The clinical data of 231 patients with pancreatic canccr who received pancreaticoduodenectomy at the Southwest Hospital from January 2006 to December 2011 were retrospectively analyzed.All the patients were divided into the combined vascular resection and reconstruction group (97patients) and non-vascular resection and reconstruction group (134 patients).Effects of operation,results of pathological examination,prognosis and lymph node metastasis on the prognosis of the patients in the 2 groups were compared.Two independent samples t test was used to analyze the measurement data,and the count data were analyzed using the chi-square test.The survival curve was drawn by the Kaplan-Meier method,and the survival was analyzed using the Log-rank test.Results The operation time and intraoperative volume of blood loss were (554 ± 136)minutes and (1110 ± 939)rnl in the combined vascular resection and reconstruction group,and (445 ±106)minutes and (623 ±349)ml in the non-vascular resection and reconstruction group,with significant difference between the 2 groups (t =6.552,4.873,P ＜ 0.05).The mortality,morbidity and positive rate of lymph node metastasis of were 8.2％ (8/97),20.6％ (20/97) and 32.0％ (31/97) in the combined vascular resection and reconstruction group and 3.0％ (4/134),8.2％ (11 / 134) and 16.4％ (22/134) in the non-vascular resection and reconstruction group.There was no significant difference in the mortality between the 2 groups (x2=3.164,P ＞ 0.05),while significant differences in the morbidity and positive rate of lymph node metastasis were detected between the 2 groups (x2 =7.458,7.687,P ＜ 0.05).A total of 223 patients were followed up till September 2012,53 patients were with lymph node metastasis,and their median survival time was 8.4 months (range,6.9-10.0 months) ; 170 patients were with negative lymph node metastasis,and their median survival time was 18.6 months (range,15.8-21.5 months),which was significantly longer than that of patients with positive lymph node metastasis (x2=17.045,P ＜ 0.05).Of the 53 patients with lymph node metastasis,31 were in the combined vascular resection and reconstruction group,and their median survival time was 8.5 months (range,6.3-10.7 months) ; 22 were in the non-vascular resection and reconstruction group,and their median survival time was 8.3 months (range,6.1-10.5 months),with no significant difference between the 2 groups (x2 =0.022,P ＞ 0.05).Of the 178 patients with negative lymph node metastasis,64 were in the combined vascular resection and reconstruction group,and their median survival time was 13.2 months (range,9.2-17.1 months) ; 106 were in the non-vascular resection and reconstruction group,and their median survival time was 21.7 months (range,18.1-25.3 months),with significant difference between the 2 groups (x2 =11.908,P ＜ 0.05).Conclusions Although pancreaticoduodenectomy combined with vascular resection and reconstruction increases the incidence of postoperative complications,it could achieve the complete removal of tumors without significantly increasing the mortality rate.For patients with lymph node metastasis,pancreaticoduodenectomy combined with vascular resection and reconstruction has no influence on the postoperative survival time,while it might have influence on the patients without lymph node metastasis.
