腹腔镜保脾胰体尾整块切除手术治疗胰腺癌的技术细节及预后

doi:10.3969/j.issn.1006-7795.2017.05.019

首都医科大学学报 ›› 2017, Vol. 38 ›› Issue (5): 733-739.doi: 10.3969/j.issn.1006-7795.2017.05.019

腹腔镜保脾胰体尾整块切除手术治疗胰腺癌的技术细节及预后

孙志鹏, 朱昱冰, 阿民布和, 樊庆, 李天雄, 张能维

首都医科大学附属北京世纪坛医院肿瘤外科, 北京大学第九临床医学院, 北京 100038

收稿日期:2017-02-28 出版日期:2017-09-21 发布日期:2017-10-18
通讯作者: 张能维 E-mail:zhangnw1@sohu.com
基金资助:
北京市医院管理局扬帆重点课题基金资助（ZYLX201512）。

Detail of the en-bloc technique and prognosis of spleen-preserving laparoscopic distal pancreatectomy for pancreatic cancer

Sun Zhipeng, Zhu Yubing, Aminbuhe, Fan Qing, Li Tianxiong, Zhang Nengwei

Department of Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Peking University Ninth School of Clinical Medicine, Beijing 100038, China

Received:2017-02-28 Online:2017-09-21 Published:2017-10-18
Supported by:
This study was supported by Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support(ZYLX201512).

摘要/Abstract

摘要： 目的阐述腹腔镜保脾胰体尾整块切除手术的技术细节，并对其治疗胰腺癌的短期、长期肿瘤学预后及合并症情况进行评价。方法采用回顾性病例对照分析的方法，研究对象为北京世纪坛医院2007年1月1日至2010年1月1日间术前诊断为I期、Ⅱ期胰体尾癌，且无脾门淋巴结转移的23例病人，其中17例接受腹腔镜保脾胰体尾整块切除手术，同期6例行脾切除的腹腔镜胰体尾整块切除手术，对两组的手术时间、术中出血等术中情况，近期、远期肿瘤学预后及合并症情况进行汇总分析，并与开腹手术的同期文献报道的相关指标进行比较。结果 6例腹腔镜保脾胰体尾整块切除手术的平均手术时间为（203±54） min。平均出血量为（208±106） mL。1例由于严重的腹腔粘连中转开腹。短期合并症率为47%（n=8），胰瘘的发生率为41%（n=7）。无围术期死亡病例。肿瘤平均直径为（32±12） mm，平均淋巴结获得数量为（19.8±9.3）个。切缘均为阴性。病人的1、3、5年总生存率分别为64.7%、52.9%、41.2%，无复发生存率分别为58.8%、47.1%、35.3%。这些指标与同时期行脾切除的腹腔镜胰体尾手术及同期开腹胰体尾手术报道相比，差异无统计学意义。结论腹腔镜保脾胰体尾整块切除手术治疗术前诊断为I期、Ⅱ期，且无脾门淋巴结转移的胰体尾癌，具有可接受的近期、远期肿瘤学预后及手术合并症发生率。

关键词: 腹腔镜保脾胰体尾整块切除手术, 胰腺癌, 整块切除技术, 根治性顺势胰体尾脾切除术

Abstract: Objective The aim of our study was to illustrate the detail of the spleen-preserving en-bloc technique as while as the short-term, long-term outcomes. Methods Describe the detail of the en-bloc technique with pictures. Evaluate the prognosis of successive 23 cases who underwent the laparoscopic distal pancreatectomy (LDP) surgery. There were 17 cases that underwent spleen-preserving LDP while 6 cases underwent spleen-resecting LDP. Results The average surgery time was (203 ±54)minutes, the average blood loss volume was (208 ±106)mL. One case was transferred to open surgery because of severe adhesion. The complication rate was 47% (n=8) in short-term after surgery. Pancreatic fistula rate was 41% (n=7). No lethal case occurred. The average diameter of the tumor was (32 ±12)mm. Average number of the lymph nodes obtained was (19.8 ±9.3). All the cutting edges were negative. Survival rate of the patient after 1, 3, 5 years were 64.7%, 52.9% and 41.2%. These records showed no statistical significance compared with spleen-resecting LDP and open distal pancreatectomy (ODP) surgeries. Conclusion The en-bloc spleen-preserving LDP can be performed by experienced surgeons. This surgery has good short-term and long-term outcome.

Key words: spleen-preserving laparoscopic distal pancreatectomy, pancreatic cancer, en-bloc technique, radical antegrade modular pancreaticosplenectomy

中图分类号:

R735.9

孙志鹏, 朱昱冰, 阿民布和, 樊庆, 李天雄, 张能维. 腹腔镜保脾胰体尾整块切除手术治疗胰腺癌的技术细节及预后[J]. 首都医科大学学报, 2017, 38(5): 733-739.

Sun Zhipeng, Zhu Yubing, Aminbuhe, Fan Qing, Li Tianxiong, Zhang Nengwei. Detail of the en-bloc technique and prognosis of spleen-preserving laparoscopic distal pancreatectomy for pancreatic cancer[J]. Journal of Capital Medical University, 2017, 38(5): 733-739.

参考文献

[1] Merkow J, Paniccia A, Edil B H. Laparoscopic pancreaticoduodenectomy:a descriptive and comparative review[J]. Chin J Cancer Res, 2015, 27(4):368-375.
[2] Postlewait L M, Kooby D A. Laparoscopic distal pancreatectomy for adenocarcinoma:safe and reasonable?[J]. J Gastrointest Oncol, 2015, 6(4):406-417.
[3] Strasberg S M, Drebin J A, Linehan D. Radical antegrade modular pancreatosplenectomy[J]. Surgery, 2003, 133(5):521-527.
[4] Mitchem J B, Hamilton N, Gao F, et al. Long-term results of resection of adenocarcinoma of the body and tail of the pancreas using radical antegrade modular pancreatosplenectomy procedure[J]. J Am Coll Surg, 2012, 214(1):46-52.
[5] 杨尹默. 胰十二指肠切除术中淋巴结清扫范围争议与共识[J]. 中国实用外科杂志, 2016, 36(8):843-846.
[6] 杨尹默. AJCC第八版及日本胰腺学会第七版胰腺癌TNM分期的更新要点及内容评介[J]. 中华外科杂志, 2017, 55(1):20-23.
[7] Kishi Y, Shimada K, Hata S, et al. Definition of T3/4 and regional lymph nodes in gallbladder cancer:which is more valid, the UICC or the Japanese staging system?[J]. Ann Surg Oncol, 2012, 19(11):3567-3573.
[8] Kondo S. Japanese Pancreas Society Staging Systems for Pancreatic Cancer[M]. New York:Springer, 2003.
[9] Shimada K, Sakamoto Y, Sano T, et al. Prognostic factors after distal pancreatectomy with extended lymphadenectomy for invasive pancreatic adenocarcinoma of the body and tail[J]. Surgery, 2006, 139(3):288-295.
[10] Kooby D A, Gillespie T, Bentrem D, et al. Left-sided pancreatectomy:a multicenter comparison of laparoscopic and open approaches[J]. Ann Surg, 2008, 248(3):438-446.
[11] Yamamoto J, Saiura A, Koga R, et al. Improved survival of left-sided pancreas cancer after surgery[J]. Jpn J Clin Oncol, 2010, 40(6):530-536.
[12] Redmond K J, Wolfgang C L, Sugar E A, et al. Adjuvant chemoradiation therapy for adenocarcinoma of the distal pancreas[J]. Ann Surg Oncol, 2010, 17(12):3112-3119.
[13] Sugiura T, Okamura Y, Ito T, et al. Surgical Indications of distal pancreatectomy with celiac axis resection for pancreatic body/tail cancer[J]. World J Surg, 2017, 41(1):258-266.
[14] 施思, 项金峰, 徐近, 等. 2016版国际胰腺外科研究组术后胰瘘定义和分级系统更新内容介绍和解析[J]. 中国实用外科杂志, 2017, 37(2):149-152.
[15] De Rooij T, Sitarz R, Busch O R, et al. Technical aspects of laparoscopic distal pancreatectomy for benign and malignant disease:review of the literature[J]. Gastroenterol Res Pract, 2015, 2015:472906.
[16] Edge S B. AJCC Cancer Staging Manual, 6th edn[M]. New York:Springer, 2005.
[17] Okada K, Kawai M, Tani M, et al. Surgical strategy for patients with pancreatic body/tail carcinoma:who should undergo distal pancreatectomy with en-bloc celiac axis resection?[J]. Surgery, 2013, 153(3):365-372.
[18] Kim S H, Kang C M, Satoi S, et al. Proposal for splenectomy-omitting radical distal pancreatectomy in well-selected left-sided pancreatic cancer:multicenter survey study[J]. J Hepatobiliary Pancreat Sci, 2013, 20(3):375-381.
[19] 陈汝福, 周泉波. 神经周围浸润在胰腺癌病人预后中的意义[J]. 中华肝脏外科手术学电子杂志, 2014, (2):4-6.
[20] 迟学成. 腹部巨大肿瘤临床特点与治疗分析[J]. 中华肿瘤防治杂志,2015,22(10):806-808.
[21] Kawabata A, Hamanaka Y, Suzuki T. Potentiality of dissection of the lymph nodes with preservation of the nerve plexus around the superior mesenteric artery[J]. Hepatogastroenterology, 1998, 45(19):236-241.

腹腔镜保脾胰体尾整块切除手术治疗胰腺癌的技术细节及预后

Detail of the en-bloc technique and prognosis of spleen-preserving laparoscopic distal pancreatectomy for pancreatic cancer

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 6

编辑推荐

Metrics

本文评价

[1]	张媛媛, 葛洋, 安广宇. 双肾上腺素样激酶1不同剪接体通过激活JNK通路增强胰腺癌细胞的增生能力[J]. 首都医科大学学报, 2019, 40(2): 179-185.
[2]	王佳, 乐凯, 郭懿樊, 郭旭, 张涛, 任宇, 王睿斌, 许光中, 郑海亮, 冯树理, 朱斌. 同步辐射X线相衬成像对裸鼠胰腺癌的早期诊断[J]. 首都医科大学学报, 2019, 40(2): 195-200.
[3]	李炳秋, 张玉祥. Notch1和Notch2对胰腺癌HPAC细胞中Hes家族靶基因的不同调控作用[J]. 首都医科大学学报, 2015, 36(2): 244-250.
[4]	张凯举;余和芬;张玉祥. 人源性Notch1跨膜段真核表达载体的构建及鉴定[J]. 首都医科大学学报, 2009, 30(4): 500-503.
[5]	孔璐;张玉祥;孙林;马慧苹;贺旭;谢千池;李宝红. 人胰腺癌细胞株HPAC和BxPC-3中Src/MAPK信号转导途径中pp60c-Src和pERK1/2表达的差异[J]. 首都医科大学学报, 2008, 29(5): 589-592.
[6]	任金帅;李双;宋茂民. 应用表达载体介导siRNA抑制胰腺癌skp2基因表达的研究[J]. 首都医科大学学报, 2008, 29(5): 610-614.