CAJ | 학술논문

目的探讨一种标准化处理胰头癌切除标本的方法对肉眼判断边缘阴性而病理报告阳性(R1)切缘发生率的影响.方法 2010年11月-2013年6月,前瞻性收集北京大学第三医院普外科同一手术组对胰头肿瘤行胰头十二指肠切除术的临床和病理资料,获得由病理证实为胰腺导管腺癌的患者60例(标准化组,n=60),除取胰颈断端、胆总管断端、胃体空肠断端外,还用缝线或不同颜色标记胰头前表面、肠系膜上静脉(SMV)沟切缘、肠系膜上动脉(SMA)切缘与胰头后表面,采用规范的方法对标本进行取材.以切缘检出肿瘤细胞为R1.回顾分析我科同一手术组2006年1月一2010年11月68例胰腺导管腺癌行根治性胰十二指肠切除的资料(非标准化组,n=68),对两组资料进行比较.结果标准化组和非标准化组在年龄、性别、肿瘤分级、肿瘤大小、T分期、手术方式及淋巴结转移等方面均无明显差异.标准化组R1切缘发生率(24/60,40.0％)高于非标准化组(11/68,16.2％,x2=9.106,P=0.003).SMV沟切缘(12/31,38.7％)和SMA切缘(13/31,41.9％)是最常受累及的切缘.29.2％(7/24)的患者同时累及两个切缘.结论对胰头癌切除标本进行标准化处理能够显著提高R1切缘的发生率,其中SMV沟切缘和SMA切缘是R1发生率最高的部位.
목적 탐토일충표준화처리이두암절제표본적방법대육안판단변연음성이병리보고양성(R1)절연발생솔적영향.방법 2010년11월-2013년6월,전첨성수집북경대학제삼의원보외과동일수술조대이두종류행이두십이지장절제술적림상화병리자료,획득유병리증실위이선도관선암적환자60례(표준화조,n=60),제취이경단단、담총관단단、위체공장단단외,환용봉선혹불동안색표기이두전표면、장계막상정맥(SMV)구절연、장계막상동맥(SMA)절연여이두후표면,채용규범적방법대표본진행취재.이절연검출종류세포위R1.회고분석아과동일수술조2006년1월일2010년11월68례이선도관선암행근치성이십이지장절제적자료(비표준화조,n=68),대량조자료진행비교.결과 표준화조화비표준화조재년령、성별、종류분급、종류대소、T분기、수술방식급림파결전이등방면균무명현차이.표준화조R1절연발생솔(24/60,40.0％)고우비표준화조(11/68,16.2％,x2=9.106,P=0.003).SMV구절연(12/31,38.7％)화SMA절연(13/31,41.9％)시최상수루급적절연.29.2％(7/24)적환자동시루급량개절연.결론 대이두암절제표본진행표준화처리능구현저제고R1절연적발생솔,기중SMV구절연화SMA절연시R1발생솔최고적부위.
Objective To explore a standard technique for the processing and reporting the R1 rate of the pancreatic head cancer.Methods We present a single team experience with 60 consecutive macroscopic complete pancreatic head resections for pancreatic ductal adenocarcinoma (PDAC) carried out between Nov 2011 and Jun 2013 by using standardized pathological protocol (SP,n =60).The pancreatic transection margin,as well as the bile duct and stomach/jejunum margins and the circumferential soft margins (SMV groove margin,SMA margin and posterior surface),were sampled and analyzed.R1 was defined as tumor cells are present at the surface of the margins.Sixty-eight consecutive macroscopic complete pancreatic head resections carried out for PDAC without a standardized potocol between Jan 2006 and Nov 2010 were used as a control group(NSP,n =68).Results There was no difference between SP group and NSP group in tumor T stage,lymph node metastasis and operation type.However,there was a statistically significant difference in the R1 rate between the groups,with 16.2％ (11/68) in NSP group and 40.0％ (24/60) in SP group (x2 =9.106,P =0.003).SMV groove margin (12/31,38.7％) and SMA margin (13/31,41.9％) were the two most often involved margins.Both margins were involved in 7 cases (7/24,29.2％).Conclusions The standardized technique significantly detected higher R1 rate of the resection margin for the pancreatoduodenectomy specimen.SMV groove margin and SMA margin were the two most frequently involved margins.