中国实用外科杂志

中国实用外科杂志

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侵及胰腺段胆管的中段胆管癌行联合部分胰腺切除的扩大肝外胆管切除与胰十二指肠切除疗效对比研究

尹    磊a，方    征a，袁    波a，俞文隆a，邱应和a，沈宁佳a，姜小清b，张宝华c，张永杰a   

  1. 海军军医大学东方肝胆外科医院  a.胆道二科 b.胆道一科 c.腹腔镜科，上海200438
  • 出版日期:2018-09-01 发布日期:2018-09-07

  • Online:2018-09-01 Published:2018-09-07

摘要：

目的    对比联合部分胰腺切除的扩大肝外胆管切除与胰十二指肠切除术治疗侵及胰腺段胆管的中段胆管癌（MCIPB）的疗效。方法    回顾性分析2010年1月至2015年12月海军军医大学东方肝胆外科医院收治的41例MCIPB病人的临床资料。选择对MCIPB预后可能产生影响的临床因素进行生存分析。结果    共41例MCIPB病人，其中行联合部分胰腺切除的扩大肝外胆管切除术（APPER）23例（APPER组），全部行扩大肝外胆管切除+部分胰腺切除+No.8、9、12、13淋巴结清扫+肝总管空肠Roux-en-Y吻合；行胰十二指肠切除术（PD）18例（PD组），其中5例行保留幽门的胰十二指肠切除术（PPPD）。APPER组病人中位生存时间为15个月，1、3、5年存活率分别为69.6%、34.8%及0；PD组病人中位生存时间为21.5个月，1、3、5年存活率分别为55.5%、33.3%及22.2%。两组总生存时间差异无统计学意义（P=0.59）。多因素分析显示，R1切除是影响生存的危险因素。结论    对于部分MCIPB病人，APPER可实现与PD同等疗效，但须谨慎挑选入选病例，术中多点取材保证阴性切缘是行APPER成功的关键。

关键词: 胆管癌, 胆管切除术, 胰十二指肠切除术

Abstract:

Associating partial pancreatectomy and extended extrahepatic bile duct resection VS. pancreatoduodenectomy for the middle cholangiocarcinoma involving the pancreas bile duct: clinical analysis of 41 cases        YIN Lei* ,FANG Zheng,YUAN Bo, et al. *No.2 Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai 200438, China
Corresponding author:ZHANG Yong-jie, E-mail：510531179@qq.com
YIN Lei,FANG Zheng are the first authors who contributed equally to the article
Abstract    Objective    To compare the effect of associating partial pancreatectomy and extended extrahepatic bile duct resection with pancreaticoduodenectomy in the treatment of the middle cholangiocarcinoma involving the pancreas bile duct (MCIPB). Methods    The clinical features, surgical methods and follow-up results of 41 patients with MCIPB were retrospectively analyzed from January 2010 to December 2015 in Eastern Hepatobiliary Surgery Hospital.Clinical factors that may affect the prognosis of the MCIPB were included in Kaplan-Meier analysis. Results    Operations were performed in all 41 patients of MCIPB, including 23 patients of associating partial pancreatectomy and extended extrahepatic bile duct resection (APPER) and 18 patients of pancreaticoduodenectomy (PD), in which 5 were performed with pylorus-preserving pancreaticoduodenectomy (PPPD).The median survival time of the patients in the APPER group was 15 months, and the survival rate in 1, 3 and 5 years was 69.6%, 34.8% and 0% respectively.The median survival time in PD group was 21.5 months, and the survival rate in 1, 3 and 5 years was 55.5%, 33.3% and 22.2%, respectively.There was no statistically significant difference between the two groups (P=0.59).Multivariate analysis suggests that R1 resection was the only risk factor for survival. Conclusion    APPER can obtain a certain clinical curative effect for part of MCIPB, but pancreatic-biliary surgeons should select suitable cases carefully.It is the key for APPER to ensure the negative margin.

Key words: cholangiocarcinoma, bile duct resection, pancreatoduodenectomy