联合腹腔干的胰体尾切除和血管变异的临床分析
Clinical study on distal pancreatectomy with en bloc celiac axis resection with analysis of vascular variation
Received date: 2018-05-02
Online published: 2020-04-25
目的: 研究联合腹腔干的胰体尾切除（distal pancreatectomy with en bloc celiac axis resection, DP-CAR）对扩大根治局部进展期胰体尾癌的近期临床疗效,并探讨血管变异对DP-CAR术后并发症发生的影响。方法: 回顾性研究43例行DP-CAR且术后病理结果均为胰腺导管腺癌的病例,分析R0切除率和围术期手术并发症发生率、死亡率等,比较有无血管变异对术后并发症发生的影响。结果: 本研究DP-CAR的R0切除率达81.4%,围术期死亡率为7.0%,并发症发生率为46.5%。腹腔血管变异8例。血管变异组与无血管变异组术后并发症发生率为3/8（37.5%）比17/35（48.6%）,P=0.535,死亡率为1/8（12.5%）比2/35（5.7%）,P=0.224,组间差异均无统计学意义。结论: DP-CAR具有一定的优越性,安全可行。血管变异对DP-CAR术后并发症发生无显著影响。
关键词： 联合腹腔干切除的胰体尾扩大根治术; 术后并发症; 血管变异; 局部进展期胰体尾癌
陈梦闽, 赵舒霖, 金佳斌, 秦凯, 邓侠兴, 沈柏用, 彭承宏 . 联合腹腔干的胰体尾切除和血管变异的临床分析[J]. 外科理论与实践, 2020 , 25(02) : 134 -138 . DOI: 10.16139/j.1007-9610.2020.02.010
Objective: To analyze the short-term efficacy of distal pancreatectomy with en bloc celiac axis resection (DP-CAR) in the treatment of locally advanced pancreatic body or tail cancer and the effect of vascular variation on morbidity after DP-CAR. Methods: A retrospective study was undertaken of 43 cases with pancreatic ductal adenocarcinoma diagnosed by pathological examination in the treatment of DP-CAR. R0 resection, morbidity and mortality were analyzed perioperatively with the effect of vascular variation. Results: R0 resection by DP-CAR was 81.4% in this study with mortality 7.0% and morbidity 45.6%. Eight cases were found with vascular variation. The postoperative morbidity in the group with vascular variation and in the group without vascular variation was 3/8 (37.5%) vs 17/35 (48.5%) and the mortality 1/8 (12.5%) vs 2/35 (5.7%), respectively. There was no significant difference statistically in morbidity and mortality between 2 groups. Conclusions: DP-CAR has the advantage of safety and feasibility. There would be no effect of vascular variation on morbidity after DP-CAR.
| [1] | Hartwig W, Gluth A, Hinz U, et al. Outcomes after extended pancreatectomy in patients with borderline resectable and locally advanced pancreatic cancer[J]. Br J Surg, 2016, 103(12):1683-1694. |
| [2] | Gong H, Ma R, Gong J, et al. Distal pancreatectomy with en bloc celiac axis resection for locally advanced pancrea-tic cancer: a systematic review and meta-analysis[J]. Medicine(Baltimore), 2016, 95(10):e3061. |
| [3] | Christein JD, Kendrick ML, Iqbal CW, et al. Distal pancreatectomy for resectable adenocarcinoma of the body and tail of the pancreas[J]. J Gastrointest Surg, 2005, 9(7):922-927. |
| [4] | Barreto SG, Shukla PJ, Shrikhande SV. Tumors of the pancreatic body and tail[J]. World J Oncol, 2010, 1(2):52-65. |
| [5] | Amano H, Miura F, Toyota N, et al. Is pancreatectomy with arterial reconstruction a safe and useful procedure for locally advanced pancreatic cancer?[J]. J Hepatobi-liarypancreat Surg, 2009, 16(6):850-857. |
| [6] | Vainshtein JM, Schipper M, Zalupski MM, et al. Prognostic significance of carbohydrate antigen 19-9 in unresectable locally advanced pancreatic cancer treated with dose-escalated intensity modulated radiation therapy and concurrent full-dose gemcitabine: analysis of a prospective phase 1/2 dose escalation study[J]. Int J Radiat Oncol Biol Phys, 2013, 86(1):96-101. |
| [7] | Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic Adenocarcinoma, Version 2 2017, NCCN Clinical Practice Guidelines in Oncology[J]. J Natl Compr Canc Netw, 2017, 15(8):1028-1061 |
| [8] | Tanaka E, Hirona S, Tsuchikawa T, et al. Important technical remarks on distal pancreatectomy with en-bloc ce-liac axis resection for locally advanced pancreatic body cancer[J]. J Hepatobiliary Pancreat Sci, 2012, 19(2):141-147. |
| [9] | Nakamura T, Hirano S, Noji T, et al. Distal pancreatectomy with en bloc celiac axis resection (modified appleby procedure) for locally advanced pancreatic body cancer: a single-center review of 80 consecutive patients[J]. Ann Surg Oncol, 2016, 23(Suppl 5):969-975. |
| [10] | Hirano S, Kondo S, Hara T, et al. Distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer: long-term results[J]. Ann Surg, 2007, 246(1):46-51. |
| [11] | Takahashi Y, Kaneoka Y, Maeda A, et al. Distal pancreatectomy with celiac axis resection for carcinoma of the body and tail of the pancreas[J]. World J Surg, 2011, 35(11):2535-2542. |
| [12] | Beane JD, House MG, Pitt SC, et al. Distal pancreatectomy with celiac axis resection: what are the added risks?[J]. HPB(Oxford), 2015, 17(9):777-784. |
| [13] | 戚峰, 邰升. 联合腹腔干切除的胰体尾癌根治术[J]. 中华肝脏外科手术学电子杂志, 2017, 6(3):168-171. |
| [14] | Yamagami T, Yoshimatsu R, Kajiwara K, et al. Arterio-graphy after embolization before distal pancreatectomy with en bloc celiac axis resection[J]. Minim Invasive Ther Allied Technol, 2015, 24(6):350-355. |
| [15] | Christians KK, Pilgrim CH, Tsai S, et al. Arterial resection at the time of pancreatectomy for cancer[J]. Surgery, 2014, 155(5):919-926. |
| [16] | Mittal A, de Reuver PR, Shanbhag S, et al. Distal pancreatectomy, splenectomy, and celiac axis resection (DPS-CAR): common hepatic arterial stump pressure should determine the need for arterial reconstruction[J]. Surgery, 2015, 157(4):811-817. |
| [17] | Okada K, Kawai M, Tani M, et al. Preservation of the left gastric artery on the basis of anatomical features in patients undergoing distal pancreatectomy with celiac axis en-bloc resection(DP-CAR)[J]. World J Surg, 2014, 38(11):2980-2985. |
| [18] | Sato T, Saiura A, Inoue Y, et al. Distal pancreatectomy with en bloc resection of the celiac axis with preservation or reconstruction of the left gastric artery in patients with pancreatic body cancer[J]. World J Surg, 2016, 40(9):2245-2253. |
| [19] | Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases[J]. Ann Surg, 1994, 220(1):50-52. |
| [20] | Egorov VI, Petrov RV, Lozhkin MV, et al. Liver blood supply after a modified Appleby procedure in classical and aberrant arterial anatomy[J]. World J Gastrointesti Surg, 2013, 5(3):51-61. |
/
| 〈 |
|
〉 |
