规范化区域淋巴结清扫在胰十二指肠切除术中的价值及意义

摘要

目的 探讨规范化区域淋巴结清扫结合胰十二指肠切除术治疗胰头癌的临床价值及意义.方法 在常规Whipple基础上,进行规范化区域淋巴结清扫,重点清除肠系膜根部淋巴结(14 abed)、腹主动脉旁淋巴结(16 a2b1)、以及肝十二指肠韧带内淋巴结(12 abpeh)、肝动脉旁(8组)、腹腔动脉旁(9组)淋巴结.结果 11例胰头癌病人施行以规范化区域淋巴结清扫的Whipple D2切除.常规行胰管及尾侧胰断端术中病理检查,证实无癌残留.2例合并血管侧壁切除或节段切除血管重建.全组无手术死亡,并发胰瘘1例.11例病人中有7例(63.6%)发生淋巴结转移,其中以胰头后(13组)、肠系膜根部(14组)发生率最高(36%);发生第二站淋巴结转移的比例高达57.1%.该组11例全部获随访,死亡1例.结论 规范化区域淋巴结清扫较彻底清除区域内淋巴结及后腹膜组织,同时没有增加其手术的风险性.有理由相信"胰头癌根治术"是以规范化区域淋巴结清扫为重点的Whipple D2切除,其治疗胰头癌具备手术的安全性、可行性及彻底性,但对于远期疗效,仍需大宗病例的客观评价.其有效性值得进一步去探索研究.%Objective To investigate the clinical value of standardized regional lymph node clearance in combination with pancreaticoduodenectomy for treatment of pancreatic head cancer.Methods After routine Whipple procedure, the standardized regional clearance of mesenteric root lymph node,lymph node beside the abdominal aorta,intrahepatic and intra-duodenal ligamentous lymph node,parahepatic arterial lymph node and paraceliac arterial lymph node was performed. Results A total of 11 patients were enrolled in this study. Pathological examination during the operation showed that there was no cancerous residue. Two patients received combined resection of vascular lateral wall or segmental resection and vascular reconstruction. There was no death during operation. For the 11 patients, 7 (63.6% ) had lymph node metastasis. The metastasis had the highest morbidity at the place posterior to pancreatic head and mesenteric root (36%). The occurring rate of second-station lymph node metastasis was as high as 57.1%. The follow-up in all the 11 patients revealed that 1 died. Conclusion The standardized regional lymph node clearance can be used to completely clear the lymph nodes and posterior peritoneal tissues. Meanwhile, it does not increase the risk factors for operation.Therefore,the radical resection of pancreatic head cancer can be considered as Whipple D2 resection with standardized regional lymph node clearance as the focus and it is safe and reliable for treatment of pancreatic head cancer. However, the long-term efficacy of the procedure should be further studied in larger population.